A contribution to the symptomatology and surgical treatment of spinal cord tumors / by J. Ramsay Hunt and George Woolsey.

  • Hunt, James Ramsay, 1872-1937.
Date:
1910
Catalogue details

Licence: In copyright

Credit: A contribution to the symptomatology and surgical treatment of spinal cord tumors / by J. Ramsay Hunt and George Woolsey. 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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    tender points so characteristic of neuralgia are absent. When present, these segmental root pains are of the greatest value in determining the level of the lesion, and according to Bruns are to be referred to, a compression of the segment from which the root springs, and not to pressure upon the root in its intra- spinal course, a clinical law which has an important bearing on localization. In central tumors (intramedullary) the root pains are either absent or comparatively insignificant, and this constitutes an important differential sign from the extramedul- lary growths. Exceptions are occasionally noted. The clinical picture of intramedullary tumor resembles somewhat that of a subacute or chronic transverse myelitis. The tendency to extension of the symptoms in an upward direction is frequently observed, and is another distinguishing feature from growths without the cord. In extramedullary neoplasms, on the other hand, the course of the affection sug- gests that the tumor is growing in width, and not increasing in length,—a clinical fact emphasized by Oppenheim, and which I have had frequent opportunity to verify. In central tumors (gliosis and glioma), vasomotor and trophic disturbances are of frequent occurrence, as well as a spinal deformity without pain or tenderness (kypho-scoliosis). Very characteristic also is a homolateral dissociated anaesthesia of segmental distri- bution (posterior horn anaesthesia). In extramedullary growths, root pains and root anaesthesias are present on the side of the tumor, and a contralateral anaesthesia below the level of the lesion. A dissociated anaesthesia (loss of pain and temperature sense) cannot be regarded as characteristic of central tumors, and may be encountered in vertebral and exti amedullary localizations as well. I have observed, how- cver, that the tactile sense, under these circumstances while Present, is definitely obtunded when compared with a normal aiea, which in some cases serves to separate this form of sensory disturbance from the dissociated ancesthesia of the syringo-myelic type. Atiophic palsies occur both in central tumors with invasion of the anteiior horns and in eccentric growths involving the o O