have in every respect a great resemblance to those which are situated
higher and affect the cord proper. “They are hard to distinguish from
the latter, but may be in many cases perhaps, if it is borne in mind
that tumors of the cauda produce exclusively nerve-root symptoms, and
that the signs of compression of the cord, of secondary myelitis, etc.
are absent. The higher the tumor, the nearer it approaches the lumbar
{1105} portion of the cord, the harder will it be to draw the
distinction. In respect to tumors seated lower the following points
may be attended to: the seat of the pains (which in such cases often
attain enormous violence) is strictly localized in certain
nerve-districts; all nerves leaving the spinal canal above the tumor
are free; thus in myxo-sarcoma telangiectodes of the cauda I observed
the pain strictly limited to the district of the sciatica, while the
crural and the dorsal nerves were perfectly free; constant violent
pain in the sacrum. If palsy occurs the reflex actions necessarily
cease at once. Spasms are seldom observed, more frequently
contractures. Atrophy of the muscles occurs rather frequently. The
palsy and anæsthesia by their localization often give us the
opportunity of fixing the upper limit of the lesion. Increase of the
reflex acts and marked tendinous reflexions do not occur. Paraplegia,
palsy of the bladder, bed-sores, etc. may develop exactly as in tumors
occupying a higher seat, {1106} but the symptoms of paralysis do not
seem to belong necessarily to the disease, as is shown in my case
(just mentioned), which terminated fatally before paralysis or
anæsthesia occurred.”
[Footnote 10: _Op. cit._]
[Illustration: FIG. 53.]
[Illustration: FIG. 54. Psammoma of Dorsal Cord, 38 of Table (after
Charcot).]
PROGNOSIS.—The prognosis of spinal tumors is generally very
unfavorable. Syphilitic cases are of course the most hopeful, but even
in these cases it is only when they are recognized early that much can
be expected. A gumma that has grown to any dimensions will have so
compressed the cord that even when the tumor is melted away by
specific treatment its effects will remain.
DURATION AND TERMINATION.—Most cases of spinal tumor last from about
six months to three years. Occasionally death may result, as from a
rapidly-developing sarcoma, in less than six months, and somewhat more
frequently in slowly-developing tumors, or in those which are held
more or less in abeyance by treatment the sufferings of the patient
are prolonged to four or five years or more. Hemorrhages into or
around the growths sometimes take place, and are the cause of death,
or more frequently of a sudden aggravation and multiplication of
severe symptoms. Death sometimes takes place from the complete
exhaustion which results from the disease and its accompanying
secondary disorders, such as bed-sores, pyelitis, etc. Occasionally
death results from intercurrent diseases, such as pneumonia,
infectious fevers, etc., whose violence the weakened patient cannot
well withstand. Sometimes the symptoms of a rapidly-ascending
paralysis appear, probably due to an ascending myelitis or
meningo-myelitis.
COMPLICATIONS AND SEQUELÆ.—Spinal tumors are sometimes complicated
with other similar growths in the brain or the evidences of the same
constitutional infection in other parts of the body. In one case of
cysticercus of the cord sclerosis of the posterior columns was also
present.
TREATMENT.—The treatment of spinal tumors can be compressed into very
small compass. In cases with syphilitic history, or when such history
is suspected, although not admitted, antisyphilitic remedies should be
applied with great vigor. It should be borne in mind, however, that
even in syphilitic cases after destruction of the cord by compression
or softening specific remedies will be of no avail. In tubercular
cases and in those in which the system is much run down tonics and
nutritives are indicated. Bramwell[11] advises an operation in any
case in which the symptoms are urgent, in which the diagnosis clearly
indicates the presence of a tumor, when there is no evidence of
malignant disease, when the exact position of the growth can be
determined, and when a vigorous antisyphilitic treatment has failed to
produce beneficial results. As some meningitis, meningo-myelitis, or
myelitis is usually present in cases of spinal tumor, treatment for
the complication will assist in relieving the torments of the patient.
Anodynes, particularly opium and its preparations, should be used
freely in the later stages of the affection. Bromides and chloral are
of little value except in association with opiates. Operation offers
even less hope than in brain tumor, but in very rare cases should be
taken into consideration.
[Footnote 11: _Diseases of the Spinal Cord_, Edinburgh, 1884.]
{1107} TABLE OF FIFTY CASES OF SPINAL TUMOR.
1. Sex and Age: M. 33.
Clinical History: Paresis of forearms, left worse. Paraplegia, then
paralysis of all limbs; paralysis of intercostals. Contractures of
hands, then of feet. Pain and stiffness of neck on motion. Wasting of
interossei. Diplegic contractions of legs. Only partial paralysis of
sphincters. Sensation perfect. Bed-sores. Duration, thirteen months.
Path. Anat. and Location: Glioma; syringo-myelus. Dilated lymphatics.
Entire length of cord, and involving medulla oblongata. Upper four
inches of cord greatly enlarged.
Remarks: T. Whipham, _Trans. Path. Soc. London_, 1881, xxxii. 8-12.
2. Sex and Age: F. —.
Clinical History: Constricting pains about abdomen. Paresis of legs.
Persistent subsultus. Temporary improvement after labor. General
paralysis. Scoliosis.
Path. Anat. and Location: Glio-myxoma.
In gray columns from medulla oblongata to cauda equina.
Remarks: Schueppel, _Arch. d. Heilk._, viii. Bd., 1867 (quoted by
Rosenthal).
3. Sex and Age: M. 15.
Clinical History: Paresis of left arm. Pain back of neck. Later,
paralysis of left arm, and wasting of arm, shoulder, and neck muscles.
Slight paresis of right arm. Prolonged vomiting. Constriction of neck;
dysphagia; paralysis of chest.
Path. Anat. and Location: Gelatinous tumor left side of cord, and
involving in some parts the gray matter.
From medulla to sixth cervical vertebra.
Remarks: S. Wilks, _Lectures on Dis. of Nervous System_, p. 266.
4. Sex and Age: M. 18.
Clinical History: Paresis of left leg, increasing; some atrophy.
Weakness in left arm. Later, numbness in both legs. Contracture of
fingers. Some mental confusion. Left hand and leg livid and cold.
Hyperæsthesia of left leg; anæsthesia of right leg, perineum, penis,
scrotum, rectum, and inguinal region, and of left arm. Right arm
normal. Islands of heat and cold in leg, and of cold in arms. Left
ankle clonus. Left pupil contracted. Vomiting. Dysphagia.
Occipito-cervical pain and contracture of cervical muscles. Leg
contractures and tremor. Later, hyperæsthesia disappeared.
Incontinence of urine. Patellar and skin reflexes increased. Facial
spasm. Amblyopia, optic neuritis, diplopia, deafness, paralysis of
left abducens; pupils contracted. Sacral bed-sores. Thick speech.
Path. Anat. and Location: Round-celled sarcoma or glio-sarcoma,
growing from ependyma of central canal, causing hydromyelia,
softening, and secondary degeneration. Dura mater thickened. Brown
exudate in cord and base of brain.
From medulla oblongata to dorsal cord.
Remarks: Schultze (F.), _Arch. f. Psychiat._, Berlin, 1878, viii.
367-393, 1 pl.
5. Sex and Age: F. 48.
Clinical History: Pain in abdomen and down legs, worse on left side.
Tonic spasm in flexors and adductors of thighs. No anæsthesia. Two
months before death paralysis of sphincters. Great emaciation.
Path. Anat. and Location: Tumor (psammoma), growing from dura mater on
right side in cervical region.
Upper part of cervical region.
Remarks: J. Hutchinson, Jr., _Tr. Path. Soc. Lond._, 1881-82, xxxiii.
23, 24.
6. Sex and Age: ——
Clinical History: Pain in arms. Contracture of fingers of right, then
left side. Numbness in right foot, then upward, then left foot. Girdle
feeling. Priapism and dysuria. Complete anæsthesia, later, up to third
rib, with paralysis of legs and paresis of fingers. Respiration
diaphragmatic. Legs very jerky. Later, arms paralyzed.
Path. Anat. and Location: Sarcoma of left post. aspect of cord;
adjacent cord compressed and soft. Belt of yellow substance enveloped
cord to cauda equina.
Between cervical bulb and second cervical vertebra.
Remarks: E. Long Fox, _Bris. Med.-Chir. Journ._, 1883, i. 100-106, 2
pl.
7. Sex and Age: F. 31.
Clinical History: Pain, stiffness in neck; pain radiating, aggravated
by jarring. Sudden paralysis of both arms; next day paralysis of legs,
incomplete. Partial anæsthesia. Marked skin reflexes in legs. Patellar
reflexes retained, weaker on right than left. Dyspnœa. Profuse
perspiration. Cardiac irregularity. Day before death temperature in
right axilla 100°; left, 102.2°.
Path. Anat. and Location: Gumma of dura mater two inches long, with
intercurrent hemorrhage; flattening and softening of cord, with
secondary sclerosis.
From first to fifth cervical vertebra.
Remarks: Charles K. Mills, _Philada. Med. Times_, Nov. 8, 1879, p. 58.
8. Sex and Age: M. 34.
Clinical History: Pain in back of neck, with stiffness and
torticollis. Paresis of arms; later, of legs. Anæsthesia of arms, then
of legs; also paræsthesia of legs. Late symptoms: shortening and great
rigidity of neck, with choking sensation (girdle sensation at neck).
Dimness of vision. Atrophy of arms and less of legs. Complete
paralysis of arms, almost complete of legs. Electro-contractility
preserved. Violent skin reflexes in legs. Involuntary evacuations and
incomplete priapism. Severe pains in knees and ankles. No acute
bed-sores. {1108} Paroxysms of dyspnœa. Average temp. for two weeks
before death, M. 97.9°, E. 98.3°.
Path. Anat. and Location: Gumma of dura mater; caries, probably
syphilitic, of vertebræ. Abscess. Total (almost) transverse sclerosis
of cord. Secondary degeneration. Some softening above and below tumor.
Cervical nerves compressed and atrophied.
From second to fifth cervical vertebra; most in front.
Remarks: Charles K. Mills, _Philada. Med. Times_, Nov. 8, 1879, p. 58.
9. Sex and Age: M. 43.
Clinical History: Pain between shoulders. Numbness in right hand and
arm, with weakness and swelling. Numbness in left arm, which spread
over chest and abdomen. Unable at first to lie down. Felt as though
encased in armor. Pain in back of neck. Tongue protruded to right.
Exaggerated reflexes in legs. Right arm and leg weaker than left.
Vertigo. Dysphagia. Sense of constriction about neck. Breathing
impaired.
Path. Anat. and Location: At third cervical vertebra, to right of
front of cord. Destruction of opposite vertebra.
Remarks: E. H. Clark, _Bost. Med. and Surg. Journal_, 1859-60, lxi.
209-212.
10. Sex and Age: ——
Clinical History: No record of symptoms especially referable to the
cysticercus. Symptoms of tabes dorsalis.
Path. Anat. and Location: Cysticercus in substance of cord. Lesions of
tabes dorsalis.
On level with third cervical nerve.
Remarks: Geo. L. Walton, _ibid._, vol. cv. p. 511.
11. Sex and Age: M. 25.
Clinical History: Pain in back of neck; stiffness. Numbness of left
hand. Gradual loss of power of left arm. Jerking of arm. Paresis of
left leg. Constriction of upper chest. Right limbs involved, and
eventual complete paralysis of trunk and extremities. Severe headache.
Last three days absolute anæsthesia of arms and legs. No
ophthalmoscopic changes. Constipation and dysuria.
Path. Anat. and Location: Fibro-sarcoma at level of fourth cervical
nerves. Cord compressed.
Remarks: H. A. Lediard, _Tr. Path. Soc. Lond._, 1881-82, xxxiii.
25-27.
12. Sex and Age: F. 25.
Clinical History: Œdema of ankles; pain in legs; afterward numbness,
formication, and stiffness of legs. Painful contractures in upper
extremities. Slight left scoliosis. Abdominal pains. Paresis of arms.
Fingers flexed. Fever. Respiration became involved, and bowels and
bladder paralyzed. Mind clear. Died in attack of suffocation.
Duration, two years and three months.
Path. Anat. and Location: Fibroma, size hazelnut, under pia mater.
Between fourth and fifth cervical vertebræ.
Remarks: Bernhuber, _Deutsch. Klin._, Berlin, 1853, v. 406.
13. Sex and Age: M. 16.
Clinical History: Restlessness. Cramps in pharynx on swallowing.
Excitability. Delirium. Hallucination. Pain in the neck. On touching
neck general cramps. Grimaces. Salivation. In three days complete
paraplegia. No fever. Sudden change. Pulse 120. Pupils alternating.
Blepharospasm. Irregular respiration. Pulmonary œdema. Suspicion of
hydrophobia, because patient had been with hydrophobic dog; when
offered coffee had symptoms simulating rabies.
Path. Anat. and Location: Sarcoma.
Extending from fifth to seventh cervical nerve on antero-lateral face
of cord, compressing left half and penetrating into right half, so
that anterior longitudinal fissure described arc of circle around it.
Remarks: Adamkiewicz, _Arch. de Neurol._, Paris, 1882, iv. 323-336, 1
pl.
14. Sex and Age: F.
Clinical History: Paresis and partial anæsthesia in all limbs for many
months, most marked on left side. Brain and special senses unaffected.
Had a tumor at bottom of right side of neck. Extensive bed-sore.
Path. Anat. and Location: Carcinoma.
Tumor caused partial absorption of sixth cervical vertebra. Cord
compressed and twisted. Right lateral aspect especially affected. Cord
atrophied.
At level of sixth cervical vertebra.
Remarks: J. W. Ogle, _Tr. Path. Soc. Lond._, 1885, 6, vii. 40, 41.
15. Sex and Age: F. 34.
Clinical History: Pain in right foot, and paresis increasing to
paraplegia. Paresis of arms. Contractures of legs. Hyperæsthesia in
both legs up to crest of ilia. Later, great pain; paralysis of
sphincters. Bed-sores.
Path. Anat. and Location: Sarcoma, growing from dura mater; nerves
passing through and over tumor. Cord congested and pushed to one side.
Thin, but not softened. Growth resembled psammoma.
Between sixth and seventh cervical nerves of left side.
Remarks: T. Whipham, _Tr. Path. Soc. Lond._, 1873, xxiv. 15-19.
{1109} 16. Sex and Age: M. 57.
Clinical History: Pain in right arm. Numbness in hand, and paresis.
Paresis and coldness of left leg. Some anæsthesia and wasting of right
leg. Later, paraplegia. Diminished reflexes. Contractures.
Constriction sense about legs and abdomen. Triceps, deltoid, and
serratus magnus of right side paralyzed. Incontinence of urine,
difficult defecation, decubitus, fever. Abdominal muscles paralyzed.
Later, other muscles of arms paralyzed. Complete anæsthesia of legs.
Dyspnœa, œdema of lungs.
Path. Anat. and Location: Myxoma from arachnoid. Cord compressed and
softened on right postero-lateral side. Secondary degeneration. Some
œdema of brain.
At sixth and seventh cervical vertebra on postero-lateral surface of
cord.
Remarks: Pel (P. K.), _Berlin. Klin. Wochensch._, 1876, xiii. 461-463.
17. Sex and Age: F. 35.
Clinical History: First, pain in right arm, weakness in right hand.
Then paralysis almost complete in arms, and impaired sensation. In
legs paralysis complete, sensation impaired. Alternate incontinence
and dysuria. Ankle clonus and increased knee-jerks and plantar reflex.
Tapping biceps causes reflex in little and ring fingers. No atrophy or
bed-sores. Cold on one side, hot on other. Pain and little swelling
over sixth cervical vertebra. No eye symptoms. Brain clear. Inability
to turn head. Before death respiratory paralysis and bed-sores.
Duration, fifteen months.
Path. Anat. and Location: Spindle-cell sarcoma, springing from
arachnoid and destroying cord by pressure, except posterior columns.
Cord below tumor soft.
At sixth cervical vertebra.
Remarks: E. Long Fox, _Bris. Med.-Chir. Journ._, 1883, i. 100-106, 2
pl.
18. Sex and Age: M. 50.
Clinical History: Paresis in right arm. Stiffness in neck and back.
Paralysis of all extremities gradually developed.
Path. Anat. and Location: Glioma in right half of cord. Old
hemorrhages in adjacent parts and in medulla oblongata. A more recent
hemorrhage in dorsal cord.
In lower cervical region.
Remarks: Schueppel, _Arch. d. Heilk._, viii. Bd., 1867 (quoted by
Rosenthal).
19. Sex and Age: ——
Clinical History: Coldness, numbness, violent pains, first in left
arm, later in both legs. Paralysis of all limbs and muscles of trunk.
Atrophy. Reactions of degeneration. Violent leg reflexes.
Path. Anat. and Location: Tubercle, large as hazelnut. Consecutive
myelitis of adjacent parts and left anterior horn.
In lower cervical region.
Remarks: Chvostek, _Med. Press_, 33-39, 1873 (quoted by Rosenthal).
20. Sex and Age: M. 45.
Clinical History: Interscapular pain. Chest-pressure and dyspnœa.
Paræsthesia and pain in legs. Spastic paralysis. Difficulty in stools;
bloody urine and dysuria. Œdema of legs. Bed-sores. Kypho-scoliosis.
Pain on pressure over spine. Paralysis of left leg, paresis of right,
some anæsthesia of both. Broncho-pneumonia, fever.
Path. Anat. and Location: Phlegmon of dura mater, compressing cord.
Some infiltration of tissues of throat and mediastinal space.
From seventh cervical to second dorsal vertebra.
Remarks: Mankopff (E.), _Berl. Klin. Wochensch._, 1864, i. 33-46, 58,
65, 78.
21. Sex and Age: M. 22.
Clinical History: Pain in back and side of neck and in limbs. Marked
pain in sternal region on coughing. Pressure and jarring cause pain.
Rapid loss of power in both arms. Feeble and slow movements of thighs,
legs, and feet. Right deltoid and flexors of fingers much wasted. No
paralysis of face. Knee-jerks exaggerated. Later, complete paralysis,
including bladder and rectum.
Path. Anat. and Location: Tumor of membrane. Cord beneath compressed
and degenerated.
Lower cervical and upper dorsal region.
Remarks: H. C. Wood, “Proceedings of Philadelphia Neurological
Society,” _Medical News_, vol. xlviii. No. 9, Feb. 27, 1886.
22. Sex and Age: F. 50.
Clinical History: Pain in neck, shoulders, and chest. Stiffness of
neck, back, and arms. Chest fixed; breathing diaphragmatic. No
paralysis or altered sensation.
Path. Anat. and Location: Secondary cancer of vertebræ.
Cervical region.
Remarks: Gull, by Wilks, in _Lect. on Dis. of Nerv. System_.
23. Sex and Age: F. 40.
Clinical History: Severe pain in back. At height complete paralysis in
legs, some paresis in arms. Variable anæsthesia. Girdle sensation and
mammary pain. Lively and distressing reflexes. Contractures in legs.
Bed-sores and paralysis of sphincter of bladder. Toward close rigors
(pyæmia?).
Path. Anat. and Location: Fibro-cyst on right side, between cord and
dura, and between anterior and posterior nerves.
Top of dorsal region.
Remarks: Risdon Bennett, _Tr. Path. Soc. Lond._, 1855-56, vii. 41-45.
24. Sex and Age: M. 30.
Clinical History: Cough, dyspnœa, wasting, simulating phthisis. Pain
in back of neck and shoulders. Pain in joints; paresis of legs and
bladder. Pain in chest. Paresis of arms. Later, increased paralysis,
bed-sores, sweating.
Path. Anat. and Location: Tumor, size of hazelnut, inner anterior
surface of dura mater. Flattening and softening of cord.
Top of dorsal region.
Remarks: Gull, in _Guy's Hosp. Rep._, (quoted by Wilks in _Lectures on
Dis. Nerv. Syst._, p. 264).
{1110} 25. Sex and Age: F. 43.
Clinical History: Pain in shoulders, chest, and sides. Contractures of
legs; heels to nates. No anæsthesia. Later, retention of urine and
bed-sores. Incessant pain in back and abdomen.
Path. Anat. and Location: Fibro-nucleated tumor from inner surface of
dura mater.
Opposite third dorsal vertebra.
Remarks: Gull, by Wilks, _ibid_.
26. Sex and Age: F. 43.
Clinical History: Pain in chest and shoulder, then in legs. Paresis of
legs. Contractures and jerking of legs. Spasm of abdominal muscles. No
anæsthesia. Paresis of bladder and rectum. Wasting and bed-sores.
Finally, paresis increased, but never complete paralysis. Duration,
nine months.
Path. Anat. and Location: Fibro-nucleated tumor, size of a bean, from
dura mater. Cord compressed backward, and softened.
Opposite third dorsal vertebra.
Remarks: Wilks, _Trans. Path. Soc. Lond._, 1855-56, vii. 37-40.
27. Sex and Age: M. 24.
Clinical History: Paraplegia. Depressed reflexes; girdle symptom.
Partial anæsthesia. Dysuria. Vomiting. Pulse weak and intermittent.
Partial recovery from paralysis, and anæsthesia in left leg, and
reflexes in right foot regained. Later, complete paraplegia,
anæsthesia, and bed-sores. Duration, five months.
Path. Anat. and Location: Probable gumma.
Middle dorsal region.
Remarks: B. G. McDowell, M.D., _Dubl. Q. J. Med. Sci._, 1861, xxxii.
299-303.
28. Sex and Age: F. 44.
Clinical History: Paresis in legs. Spine hypersensitive and
inflexible; least attempt at bending causes great cervico-brachial
pain. Paræsthesia; sense of falling out of abdominal viscera through
abdominal walls. Pains in extremities increasing, and involving right
shoulder, intercostals on both sides, and lumbar region. Paralysis of
right arm (first); complete paralysis of leg. Excessive spinal
tenderness. Loss of sensation (partial) in legs, body, and right arm.
Later, dyspnœa, then dysuria, then complete inability to empty bowels
or bladder. Great tympanites. Girdle sense above umbilicus, and
finally complete paralysis and anæsthesia below this band. Sense of
twisting of legs and feet, so that latter seemed close to face. Œdema.
Later, paresis of left arm. One small bed-sore.
Path. Anat. and Location: Alveolar sarcoma.
Eighth and ninth dorsal vertebræ.
Remarks: G. W. H. Kemper, _Journ. Nerv. and Ment. Dis._, xii. No. 1,
Jan., 1885.
29. Sex and Age: F. 42.
Clinical History: Projection of seventh, eighth, ninth, tenth, and
eleventh dorsal vertebræ. Numbness below ankles, and early girdle
sensation. Peronei and anterior tibial muscles first involved; then
all leg-muscles, then sphincters, then arms. Died in a fit.
Path. Anat. and Location: Round-celled sarcoma. The anterior columns
soft opposite tumor. Bodies of seventh, eighth, ninth, and tenth
vertebræ soft.
Opposite seventh, eighth, ninth, and tenth dorsal vertebræ.
Remarks: E. Long Fox, _Brit. Med. Journ._, 1871, p. 566.
30. Sex and Age: F. —.
Clinical History: Ill-defined hemiplegia; later, paraplegia, with
contractures and rigidity.
Path. Anat. and Location: Gumma and syringo-myelus. Small cavities in
anterior cornua.
At ninth dorsal vertebra anterior aspect.
Remarks: Taylor, _Lancet_, 1883, p. 685.
31. Sex and Age: M. 7.
Clinical History: Paraplegia, except adductors and rotators of thigh.
Reflex contractures; most intense from irritation of penis and
scrotum. Rigidity of legs. Complete anæsthesia of lower half of body.
Later, anuria, incontinence of feces. Anal sphincter reflex; figured
stools. Cystitis. Pain on percussion in dorsal region. Pain in back.
Complete paraplegia. Very late, brain symptoms. Duration, nine months.
Path. Anat. and Location: Tubercle (?).
Cord soft for two inches.
Tenth dorsal vertebra.
Remarks: Geoghegan, _Dublin Med. Press_, 1848, xix. 148-151.
32. Sex and Age: F. 46.
Clinical History: Fixed pain in left iliac region. Paresis in left
leg, increasing to paraplegia. Formication. Girdle sensation.
Incomplete, increasing to complete, anæsthesia of legs. Spontaneous
twitchings. Bladder and sphincter ani paralyzed. Bed-sores. Duration,
one year.
Path. Anat. and Location: Fibroma (?) from inner surface of dura. Cord
hollowed out and softened.
Interval between tenth and eleventh dorsal vertebræ.
Remarks: William Cayley, _Tr. Path. Soc. Lond._, 1864-65, vol. xvi.
21-23.
33. Sex and Age: M. 30.
Clinical History: Hyperæsthesia; later, anæsthesia in legs; then
complete paraplegia.
Path. Anat. and Location: Tubercle size of pea. Adjacent myelitis. In
lower dorsal region.
Remarks: Chvostek, _Med. Presse_, 33-39, 1873 (quoted by Rosenthal).
{1111} 34. Sex and Age: M. 31.
Clinical History: Ataxia; stiffness of legs and cramps in abdomen and
legs. Slight nystagmus. Difficulty in forming words. Ataxia of arms.
Slight wasting of legs, especially of left. Lumbar pains; abdominal
cramps. Dysuria. Impotence. Later, increased spastic state of legs.
Mind depressed and emotional; attempts at suicide. Anuria. Bed-sores.
Urine albuminous. Duration, one year.
Path. Anat. and Location: Myxoma of dura mater 3 inches long. Dura
mater of brain contained fluid and lymph.
Dorsal region, left side.
Remarks: Shearman, _Lond. Lancet_, vol. ii. 1877, p. 161.
35. Sex and Age: F. 50.
Clinical History: Pains in limbs (thought to be rheumatic). Paresis in
legs. Hyperæsthesia in right leg; burning pains alternating with sense
or coldness.
Path. Anat. and Location: Cancer of vertebræ (sarcoma?).
Dorsal region.
Remarks: Gull, by Wilks, _Dis. Nerv. Syst._
36. Sex and Age: F. 35.
Clinical History: Paresis of left leg; soon of right leg. Pain in back
and left side. Tonic spasms of legs. Darting pains in knees. Partial
anæsthesia. Exalted plantar reflexes. Dysuria. Later, complete
paraplegia and anæsthesia; violent reflexes; severe pain in back.
Bed-sores. Duration, seven and a half years.
Path. Anat. and Location: Tumor, osseous or fibrous, three-fourths of
an inch long, growing from dura mater. Cord flattened, and softened
below tumor.