Ophthalmoplegia externa complicating a case of Graves' disease / by Francis Warner.

  • Warner, Francis, 1847-1926.
Date:
1883
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Licence: Public Domain Mark

Credit: Ophthalmoplegia externa complicating a case of Graves' disease / by Francis Warner. 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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    The symptoms and pathological signs in this case may be classified as those dependent upon the Graves' disease, its complications, and the ophthalmoplegia externa; in the former group may be placed the exophthalmos, goitre, palpitation with gastric crises, headaches, and dyspnoea, then the general mental excitement, vertigo, tremor of the lower extremities, weakness of the fifth and seventh pairs of nerves, with general reduction of sensibility. In most points this case corresponds with Mr. Hutchin- son's description of ophthalmoplegia externa given in vol. Ixii of the ' Transactions.' Agreement is seen in the double ptosis, a want of exact correspondence in the conditions of mobility of the two eyes, the paresis of the fifth pair of nerves, and the good vision. In six of Mr. Hutchinson's cases the lower extremities were weak, with a condition more or less approaching ataxy. In this case there was tremor of the feet without defect in walking. Two of Mr. Hutchinson's cases presented the one, insanity, the other, violent mental excitement; in the case narrated the mental excitability was marked. A difference is found in bilateral weakness of the muscles of the face. It is noteworthy that the two eyes were not equally affected with loss of mobility; this seems to strengthen the probability that there is a nerve centre governing the movements of each eye. On this point additional evidence is seen in cases where nystagmus affects the two eyes unequally; also in the independent movements of either eye seen in infants in deep sleep, and in adults in coma from chloroform.^ Again, the greater limitation of move- ments in the horizontal, as compared with the vertical plane, seems to give evidence of the greater paralysis of the nerve centre governing the horizontal movements, as compared with the degree of paralysis of the centre governing vertical movements. In the normal condition horizontal movements of the eyes are probably the most frequent, and these movements were the most paralysed. ^ Sec paper on Loss of Associated Movements of th« E\ (s und- r Chloro- form and in Disease, ' Brit. Med. Journal,' March lOtli, 1877.