Oculomotor paralysis accompanied by facial palsy, neuroparalytic keratitis and hemiplegia / by Burton Chance.

  • Chance, Burton Kollock, 1868-1965.
Date:
1909
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Licence: In copyright

Credit: Oculomotor paralysis accompanied by facial palsy, neuroparalytic keratitis and hemiplegia / by Burton Chance. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    to look up or down, yet even in the primary position there are two images, the left being the false one and the higher. The sight is good, but with the left eye objects appear far away and small. There is now partial ptosis when at rest, but by wrinkling her forehead she can draw the lid up to the limbus. There is paralysis of the superior and inferior recti, the inferior oblique, and the superior oblique muscles; the ocular excursions are limited to the extent of free adduc- tion and abduction, while supraduction is abolished and infraduction is only faintly perceptible. The diplopia is upward. There is no accommodation power, for while the woman can read types 0.50 D. with the right eye, she has great difficulty in seeing type 2 D. with her left. The vision, however, in each eye equals 5/10. The pupil of the left eye is not circular and is apparently fixed. The fundus is healthy. The cornea is perfectly smooth, and, even with the stereo- scopic loupe, nothing is found marring the clearness of the membrane. It is, however, anesthetic, and so is the conjunctiva. There is a free flow of tears. The adjustment of spherical lenses + 1.25 D. with which she sees 5/5, has relieved the woman in the past month of this annoying epiphora. The facial movements have been regained; she can wrinkle her brows and protrude her tongue straight. The face is anesthetic to pin pricks, including the nose, tongue, all of the upper part of the head except that portion comprised in a line from the lobe of the ear and ramus of the jaw forward to about three- fourths of an inch from the meridian line of the chin up beyond the angle of the mouth, thence obliquely to the ear. In order to know the patient’s general condition, I sent her to Dr. T. H. Weisenberg for an examination. He fortunately remem- bers having seen the woman in Dr. Spiller’s clinic at the Polyclinic hospital four years ago. As Dr. Weisenberg points out, the separate occurrence of left hemiplegic with left oculomotor palsy is most unusual. It is probable that the hemiplegia was caused by vascular disturbance in the right side of the brain, while the oculomotor palsy arose through a disturbance at the base on the left side, in advance of the nerve fibers supplying the extremities. The hemi- plegia has almost entirely disappeared; it is rather strange, there- fore, that the oculomotor disturbance remains. This palsy has been most extensive, affecting both the intrinsic and the extrinsic mechanisms. The widening of the palpebral fissure during the middle period of the ptosis was rather startling in appearance, and was the first instance of that phenomenon in my experinece. The facial palsy has all but disappeared, the anesthesia being the most annoying subjective symptom in this connection. It is most fortunate that the early keratitis did not extend to the true corneal tissue.