Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1179/1256 (page 1137)
    (Schlesinger, Pospelow), also tumor of the spinal cord or of the spinal cord roots. We frequently find Raynaud’s symptoms in hemiplegia; on the other hand, I am aware of no positive case of neuritis combined with Raynaud’s disease. Functional disturbances of the nervous system are common; the neurotic diathesis often paves the way for the disease. Among other symptoms we find those of neurasthenia, traumatic neurosis, chorea, epilepsy, and also of hysteria. In many of these cases Raynaud’s symptoms are merely the signs of a general neurosis, and lose their substantive character. These disturbances are most frequent on the part of the nervous system, and may be regarded as an expression of especial sensitiveness of the vasomotor system: Impaired tone of the cutaneous vessels, dermographia, tinnitus aurium, vertigo, a tendency to vomiting, to urticaria and to transitory edema. The combination with migraine and Graves’ disease has frequently been noted. Such pathologic pictures have been described by Solis-Cohen 1 and Herz 2 as vasomotor ataxia. Our knowledge of the pathological anatomy of the affection is very lim- ited, in spite of the no small number of cases in which necropsy was per- formed. Changes have been found in the peripheral nerves; to this, how- ever, I attach no causal significance; also changes of the peripheral vascular system, especially of the smaller arteries, which are, however, only of sec- ondary importance. In regard to the pathology, the vasomotor symptoms of syncope, asphyxia, and hyperemia unquestionably depend upon the abnormal irritative, and per- haps also paralytic, symptoms of the vascular nerves, yet we are unable to define all of the individual points. Gangrene is certainly not merely the consequence of vasomotor symptoms; nor can it be referred to changes in the peripheral nerves which are most likely of secondary nature, and the slight organic changes in the central nervous system so far demonstrated cannot be regarded as the cause. Nevertheless I do not doubt that the gangrene in Raynaud’s disease is a neuropathic form of gangrene. Upon the whole I regard this malady as a “ functional ” disease of the vasomotor and trophic tracts and centers. The pathogenesis of the pathologic picture does not appear to be uniform. Congenital loss of resistance and an acquired lability in which cold, intoxication, and infection play a role, perhaps also reflex changes in diseases of the peripheral organs (mostly of the vessels, rarely of the nerves) are prerequisites for the development of the affection. Whether the locus morbi is always the same has not been demonstrated. I have already stated that, at the present time, it is well not to speak of Ray- naud’s disease but of Raynaud’s symptom-complex. The diagnosis and the differentiation from other diseases must be briefly discussed. If we remember the criteria of the disease previously given, its recognition will usually not be difficult, but its relation to such affections as acroparesthesia, erythromelalgia, scleroderma and angioneurotic edema are so close, the transitional stages between these affections so ill-defined, that discrimination is not always possible, and not always desirable. The differ- 1 Solis-Cohen, “ Vasomotor Ataxia: A Contribution to the subject of Idiosyncrasies.” Am. Journ. Med. Sciences, CVII, p. 130. 2 Herz, “ Ueber vasomotorische Ataxie,” Berlin, 1902.