Landry's Paralysis.
Synonym.—Acute ascending paralysis.
Definition. — Landry's paralysis is a rapidly progressive motor paralysis of flaccid type, beginning in the extremi ties, usually the legs, extending thence upward through the trunk to the arms, and frequently to the nerves which have their origin in the lower pons-medulla region. In some instances the disease may begin above and progressively de scend.
Symptoms.—The disease begins with a , feeling of extreme weakness, occasionally associated with parresthesire, especially numbness, in the legs. This is progress ive, and in a few days or even hours there is complete motor paralysis of the lower limbs. Quite often the onset is attended with slight or, it may be in rare instances, decided elevation of temperature. Pa ralysis of the trunk-muscles follows, the sphincters escaping; and finally the mus cles of respiration and deglutition arc involved, such involvement usually ter minating the disease fatally. This order of invasion and progress is, in rare in stances, reversed. The motor cranial nerves have been said to have been af fected in one or two reported examples of the disease. Minor sensory changes, par ticularly hyperalgesia or anaesthesia, are not uncommon, though rarely conspicu ous. The deep reflexes always, the super ficial reflexes occasionally, are abolished. The mental faculties are, as a rule, nor mal, though a muttering semidelirium is sometimes observed. Bed-sores or other trophic symptoms are rare dents, though atrophy of the muscles with altered electrical reactions may pear in protracted cases. In the typical disease the cycle is completed in from ten to fifteen days.
Diagnosis.—The diagnosis is quite free from difficulties, as a rule, if the doctrine of an identity with multiple neuritis be accepted. Per contra, the rejection of this theory renders the diagnosis between the two often a very complex problem.
From fulminant forms of transverse myelitis it is to be distinguished by the involvement of bladder and rectum and the more decided sensory disturbances in the latter affection. In myelitis, too, the
deep reflexes are often exaggerated, there is the cincture symptom, trophic symp toms are of early onset and vicious ress, and the duration of acute myelitis even when most malignant is usually more protracted. The acute vascular lesions of the cord—particularly rhage, if properly localized—may closely simulate symptomatically the disease under discussion. The history of trauma, the apoplectic onset, often with convulsions, and the rapidly fatal mination are data of value in excluding Landry's paralysis.
1. There is a form of ascending flaccid paralysis, with little disturbance of sen sation, with normal electrical reactions, and without invrlvement of the sphinc ters, and this is of rapid course, usually terminating in death.
2. Other eases differ from this type by one or more atypical signs, and tran sitional forms occur, which make the diagnosis between Landry's paralysis, polyneuritis, and myelitis difficult.
3. It is possible that in some cases no lesions exist, but many of the reports of such cases date from the time when the methods of examination were very im perfect, or it may be that in these cases the lesions are in an early stage of de velopment, the patient succumbing to toxmmia before demonstrable changes in the nervous system take place.
4. Landry's paralysis may be due to myelitis alone.
5. In Landry's paralysis polyneuritis may be present, but changes in the cell bodies of the anterior horns «ill also usually be found in such cases by Nissl's stain, and it is sometimes difficult to say whether the cellular changes are pri mary or secondary.
6. It is probable, in some cases at least, that the entire peripheral motor neuron is attacked at the same time by the poison of the disease. Mills and Spiller (Jour. of Nerv. and Mental Pis., June, TS).
Etiology.—It is a disease of early or middle adult life affecting males chiefly.