The sequehu which have been noted in cases of focal encephalitis include pa ralysis, with or without spastic condi tions; contractures, atrophy, epilepsy (often Jacksonian), hemichoreas, hemi athetosis, peculiar associated movements, and imbecility, all varying in degree ac cording to the location, extent, and se verity of the inflammation. When the process is confined chiefly to the cortex, the resultant paralysis may be mono plegic, hemiplegic, paraplegic, or di plegic, according, to its extent. If oph thalmoplegia is present, which is some times associated with some degree of facial paralysis, the inflammation is usu ally found to involve the gray matter of the floor of the fourth ventricle, the aqueduct of Sylvius, and adjacent struct ures. This form corresponds to the polio encephalitis superior described by Wer nicke, Thomsen, and others.
Another form also described by Wer nicke and termed by him "polioenceplia litis inferior.' has labio-glosso-laryngeal paralysis as the elnef clinical character istic. In some cases of the latter form ophtlialmoplegia may develop during the progress of the disease. The lesion of polioencephalitis inferior has been found in the motor nuclei of the post oblongata and adjacent nerve-roots.
Some cases of acute focal encepha litis may begin insidiously, with very slight febrile reaction and gradual de velopment of paralytic symptoms.
Case in which—after slight fever— "external ophthalmoplegia, cycloplegia, iridoplegia, and ptosis with diplegia facialis" and muscular inco-ordination developed within a period of two weeks, and after a course of ten days resulted in progressive and perfect recovery. Wolfe (Jour. of Nerv. and Mental Sci., '94).
Case of a man in whom indistinctness of speech, followed by weakness of the movements of the lips, and difficulty in mastication were the first symptoms. There was then ptosis, diplopia; the knee-jerks were slightly increased; the eyes, aside from the paresis of the muscle, normal. Strychnine was steadily em ployed, with considerable improvement in the symptoms. The diagnosis was made of poliencephalitis involving the motor nuclei of the pons and medulla, the bilateral character of the symptoms being the most important indication of central origin. Walton (Boston :Med. and Surg. Jour., Feb. 1, 1900).
This type of ease is far more frequent in adults than in children, and corre sponds exactly to the description by -Wernicke of polioencephalitis superior acuta, with the exception that recovery ensued. Interesting cases of analogous symptomatology have been reported by Putnam and others, but our knowledge of the affection is mainly from the studies of German observers, including H4rtimpell, -Wernicke, Oppenhein , Nan werck, Brie, Freyhan, ard others.
Very instructive ease in a woman of 36, who exhibited loss of appetite, ab dominal pain, slight fever, liebetude, rigidity of neck-muscles, dilatation of one pipit, conm, and death, with in creased temperature. The post-mortem examination revealed numerous foci of htemorrha.gic softening throughout the substance of both cerebral hemispheres. Brie (Allg. Zeit. f. Psych., B. 53, p. 604).
Case of polienceplialitis in an adult in which a study of the clinical symptoms and the autopsical findings led to the following conclusions: (1) Landry's paralysis may be due to poliomyelitis; (2) the latter is an infectious disease, the inflammation being greatest in the an terior horns, but occurring also. in the posterior horns, the white matter, and the meninges; (3) the symptoms are motor in type, because the disease is es pecially of the anterior horns; (4) meningitis is not uncommon in polio myelitis; (5) poliomyelitis in the adult is essentially the same disease as polio myelitis in the child; (6) it is related pathologically to the non-purulent form of encephalitis and to the polienceph alitis of Wernicke. De Witt H. Sherman (Phila. Med. Jour., Mar. 31, 1900).
This type is frequent among the re ported eases.
[Nattwerek bas reported several cases, one of which illustrates how rapidly fatal the disease may- be. The patient in this case I.VaS a girl of 19, who presented the following symptoms: Headache, an Un steady or staggering gait, faintness, vomiting:, loss of pupillary light-reflex, slow pulse, fever, hebetude with restless ness, and death on the following day. The autopsy revealed focal encephalitis, surrounded by a zone of acute softening, and a bacillus identical with the bacillus of influenza was found in the lesion and also in the ventrienlar flnid. C. INtl. HAY.] The symptom-group described by Striimpell (Tillers from the Wernicke form of focal encephalitis in that paral ysis of the external eye-muscles is pres ent in the latter as a prominent symp tom, and optic neuritis is far more commonly present. The other general motor disturbances, with impairment of speech, may be identical in the two forms. When ocular-nerve palsy is as sociated with polioencephalitis,—cases of which have been reported by Rothen thal, Seeligmiiller, Guinon, Sachs, and others,—the affection is termed polio encephalomyelitis. It is extremely rare, does not occur in childhood, and runs a more or less subacute course.