Text-book of nervous diseases for physicians and students / by H. Oppenheim.

Date:
1911
Catalogue details

Licence: In copyright

Credit: Text-book of nervous diseases for physicians and students / by H. Oppenheim. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    1430/1480 (page 1378)
    cerebral symptoms, caused by compression of the cranial nerves, are also present. The disease almost always appears after the age of fifty. Diffuse hyperostosis is a disease of youth, characterised by marked increase in the size of all the cranial bones. The narrowing of the cranial fossae, the orbits and foramina, may give rise to blindness, deafness, exophthalmus, headache, dementia, etc. This condition, to which little attention has been given, is extremely rare. Bockenheimer {A. f. M. CTiir., Bd. Ixxxv.) has lately devoted a special study to it. Leontiasis ossea is a tumour-like hyperostosis of the skull, characterised by the formation of bony tumours. But, as Starr remarks, the name is applied to very different conditions. He speaks of a case in which both the cranial bones and the soft parts were affected, as one of megalocephalia. True elephantiasis, pachydermia resulting from local asphyxia, and so-called adiposis dolorosa (see p. 1365), are difficult to diagnose from acromegaly. Syringomyelia may give rise to enlargement of the distal parts (especi- ally the hands), but this is combined with the deformities and cardinal symptoms of the disease. Finally, Marie has distinguished a hypertrophic osteoarthropathy (secondarj^ hypertrophic ostitis, according to Arnold, with whom Massa- Jongo and Teleky ^ agree) from acromegaly, and has given the following differential signs :— In osteopathy the end phalanges of the fingers stand out, swollen like drum-sticks, from the large paw-like hands ; the nails are thick, bent (hke the beak of a parrot), brittle, and cracked. In acromegaly the swelling affects chiefly the soft parts, in osteopathy mainly the bones. In acro- megaly the carpo-metacarpal joint is swollen and thickened, and in osteopathy it is generally unaffected. The lower jaw is always involved in acromegaly, in which there is also thickening of the spine and cervico- dorsal cyphosis, whilst in osteopathy the lower jaw is normal and the cyphosis, if present at all, affects the lower segments of the spinal column. Examination with X-rays reveals differences between these two affections, as Thayer,^ Schittenhelm, Raynaud-Audibert, Schlagenhaufer,^ and others have shown. Osteoarthropathy usually develops in patients suffering from lung diseases (bronchiectasis, empyema, tuberculosis, sarcoma, etc.), and according to Marie it is the toxic bodies circulating in the blood which produce these changes. Further experience has shown that other pro- cesses, such as heart-diseases, chronic nephritis, choleemia, ulcerating tumours, dysentery, etc., may give rise to the affection. It has been assumed to be due to the liver in a few cases, e.g. by Gilbert-Fournier, Taylor, Smith, Klippel, and Parmentier-Castaigne. Lemercier distin- guishes between a pulmonary, cardiac, biliary, and diathetic origin. Observations by Hirschfeld, Mobius, and Berent seem to indicate that similar conditions may arise from neuritis. Hirschfeld speaks of a vaso- motor dermatohypertrophy, which leads to enlargement of the hands and feet. Marie's description of osteoarthropathy has undergone some modi- fications from later observations. The soft parts have been found to be considerably thickened (Arnold, Teleky, Schittenhelm). Indeed, 1 W. U. W., 1897. 2 Journ. Nerv. and Ment. Bis., xxv. ; Phil. Med. Journ., 1898. 3 Z. f. Heilk, 1904.