Page:Acute Poliomyelitis.djvu/73

 CHAPTER V

Symptomatology

The So-called Landry's Paralysis Type Reference has already been made to distinct and continuous progression of the paralysis from one part of the body to another. If in such cases respiratory disturbances arise, death follows fast and a symptom complex, known to literature as Landry's paralysis, thus evolves.

In 1859, Landry described a disease, characterized by flaccid paralysis, beginning in the legs, progressing upwards and termi- nating in respiratory paralysis. Sensibility remained intact or was only slightly diminished ; the electrical reactions were unaltered, and the post-mortem findings were negative. The last two fea- tures were later disproved. In an array of cases, microscopical examination demonstrated morbid changes — usually a multiple neuritis or acute myelitis, occasionally an acute poliomyelitis (Im- mermann, Monckeberg, Schmaus).

Later Wickman showed that the fatal cases of acute poliomye- litis ended in exactly the same clinical picture as Landry's paral- ysis and that many cases, which were recorded as Landry's paral- ysis with myelitic changes, were merely acute poliomyelitis. These statements were corroborated in subsequent epidemics.

This type affects mostly the leg. After initial general symp- toms, paralysis in the legs develops and progresses upwards to at- tack first the muscles of the abdomen and back, then the arm and neck, and finally bulbar symptoms appear. Cranial nerves are attacked, and as the respiratory center is implicated, dyspnea ap- pears. Death occurs on the third or fourth day. Generally, con- sciousness remains clear until the very end ; more rarely, coma precedes death ; occasionally, Cheyne-Stokes' respiration appears. Sensibility is either normal or only slightly reduced.

If the disease progresses so far as to produce respiratory dis- turbances the issue is usually fatal. If recovery does take place, signs of a widespread spinal type of the disease occasionally asso- ciated with paralysis of isolated cranial nerves persist.