Paralysis of Neck Muscles in Poliomyelitis fileDistribution of paralysis in 1,166 cases Group Number...
Transcript of Paralysis of Neck Muscles in Poliomyelitis fileDistribution of paralysis in 1,166 cases Group Number...
PARALYSIS OF NECK MUSCLES IN POLIOMYELITIS
By P. N. LAIIA, m.d.
Lecturer in Diseases of Children, Medical College, Agra
Introductory Paralysis of one or both legs is the usual
legacy of acute anterior poliomyelitis. But the
distribution of the motor loss varies within the widest limits. The paralysis may affect any muscles of the body (Collier, Adie and Walshe, 1941). According to Sheldon (1940), isolated
groups of muscles may be involved. Neck
muscles often share in ascending or generalized syndromes, but may be involved by themselves
(Wilson, 1940). Agius, Bartolo, Coleiro and
Seddon (1945) report about their study of 426 cases of poliomyelitis in the Malta epidemic (1942-43). Almost all the cases were in
children under the age of five years but none
showed paralysis of neck muscles. Bernstein, Clark and Tunbridge (1945) give an account of acute anterior poliomyelitis among service
personnel in Malta. The number of cases in
this series was 57 but in none among them was involvement of neck muscles. The appended table (table I) is given by
Lovett (1916) for the New York epidemic of 1916.
Table I
Distribution of paralysis in 1,166 cases
Group Number of
cases
Both legs One leg Both legs, both arms Both legs, one arm One arm Homolateral arm and leg One arm, one leg opposite .. 29 Both arms .. .. 33 Both arms, one leg .. 20 Girdle cases .. .. 57 Facial alone .. .. 38
338 302 127 101 83 38
Wernstedt's (Wilson, 1940) summary of the distribution of paralysis is tabulated below :?
Table II
Summary of paralysis
Localization Number Percentage
Leg .. .. .. 4,519 78.6
Arm .. .. .. 2,372 41.3
Trunk .. .. .. 1,601 27.8 vf
Cranial nerve .. .. 767 13.3
Throat and neck .. .. 333 5.8
From the tables appended above it is clear
that paralysis of the neck muscles in polio- myelitis is extremely rare. Below is reported a case of poliomyelitis in which the neck mus- cles and one arm were involved together.
Case report
N? 2 years, Muslim female child, was admitted to
the Children's Ward with the complaints of inability
558 THE INDIAN MEDICAL GAZETTE [Nov., 1945
to hold the neck erect, and diminution of motor power of the right arm, duration 15 days. The onset was
after an attack of fever which lasted for 3 days._ On examination.?Temperature, pulse and respiration
rates normal. The child could not keep the head erect on the neck. Power to extend the head_ was totally absent; the head dropped forward, causing a
peculiar attitude, which was associated witli_ overaction of the frontalis. The lower cervical spine looked
unduly prominent when the head dropped forward.
The motor power of the right arm was diminished, and there was loss of biceps and triceps jerks. Sensations
could not be tested. There were no fibrillary contrac- tures anywhere in the body. There was no other
abnormality anywhere nor in any other system. Investigation.?Blood : total red cells 4,500,000; total
white cells 11,000; haemoglobin SO per cent; poly- morphonuclears 49 per cent; lymphocytes 48 per cent; mononuclears 2 per cent; and eosinophils 1 per cent; W.R. negative. Urine and stool normal. X-ray of the cervical spine revealed no abnormality.
Progress end treatment.?An adequate dosage of vitamins including B<i and E was given to the child for 2$ months. Gradually the paralysis of neck muscles disappeared and the child could extend the neck, but the paralysis of arm showed no improvement at all, and moreover the arm looked wasted.
Comments
The interest of the case lies in the paralysis affecting the neck muscles which, as pointed out before, is a rare occurrence in poliomyelitis. Out of about 300 cases of poliomyelitis coming under the author's observation during the last 3-|- years at Agra, this is the first case in which the neck muscles shared in the paralysis. The muscles involved were the muscles of the back of the neck, the splenius, complexus, etc.
It is difficult to say how far. vitamin therapy helped in the disappearance of the paralysis of the neck muscles. The fact that no improve- ment occurred in the paralysis of the arm
stands against the beneficial value of vitamin therapy. The author feels that the regaining of power of the neck muscles probably would have occurred even if no vitamins were given. My thanks are due to Major-General H. C. Buckley,
M.D., f.r.c.s., c.s.i., i.M.S., Principal, Medical College, and Superintendent, Thomason Hospital, Agra, for his kind permission to publish the report of the case.
REFERENCES
Aoius, T., Bartolo, A. B. M. J., i, 759-762. E., Coleiro, C., and Seddon, H. J. (1945).
Bernstein H G. G? Ibid., 763-707. Clark, J. M. P., and Tunbridge. R. E. (1945).
Collier, J., Adie, W. J., Price's Textbook of the and Walshe, F. M. R. Practice of Medicine. (1941). Oxford University Press
London, p. 1571." Lovett. R. W. (1916) .. The Treatment of Infantile
Paralysis. P. Blakiston's Son and Co., Philadelphia.
Sheldon, W. (1940) .. Diseases of Infancy and Childhood. J. and A. Churchill, Ltd., London.
Wilson, S. A. IC. (1940). Neurology, 1, 234. Edward _[ Arnold and Co., London.