A CASE OF 
CROSSED HEMIPLEGIA. 
MOST PROMINENT PHENOMENON. 
PARALYSIS OF THE PHARYNX. 
SYPHILITIC BASIS. 
BY 
HEINRICH STERN, M. D. 
REPRINTED FROM THE 
Neil? 'Fortt ^eUt'cal journal 
for May 1, 1897. Reprinted from the New York Medical Journal 
for May 1, 1897. 
A CASE OF CROSSED HEMIPLEGIA. 
MOST PROMINENT PHENOMENON. 
PARALYSIS OF THE PHARYNX. SYPHILITIC BASIS. 
By HEINRICH STERN, M. D. 
On- the evening of February 10, 1896, I was sum- 
moned to attend E. F. W., who, according to the messen- 
ger, was seized with a suffocative attack. 
Patient, a man, of German parentage, aged thirty- 
four years, five feet seven inches in height, rather spare 
in flesh, single; no occupation. He was at home and ap- 
parently in his usual condition, when occasion arose to 
blow his nose; he did so, and immediately thereafter felt 
a peculiar sensation in the nasopharynx, and in attempt- 
ing to take a drink he found that he was not able to 
swallow except with much difficulty. A ':ttle while 
later, on trying to drink a glass of beer, he began to choke, 
and then I was called. 
On inspection of his exterior it seemed to me as if 
the region of the larynx and the larynx itself were much 
tumefied and swollen. There was some drooping of the 
left angle of the mouth, with an immobile condition of 
that side of the face. The left upper eyelid drooped con- 
siderably-ptosis-but I was informed that such was al- 
ways the case. There seemed to be some stiffness of the 
cervical muscles. 
The right arm was very much $ve^en$d; patient 
Copybight, 1897, by D. Appleton and Company. 2 
A CASE OF CROSSED HEMIPLEGIA. 
seemed to have but very little strength therein. The 
right leg was markedly paretic. On examining the buccal 
cavity and parts beyond by reflected light, nothing abnor- 
mal was discovered; glottis and larynx presented a natu- 
ral appearance. 
Speech was unimpaired. 
The paralysis of the pharynx was the most striking 
of the whole paretic phenomena, the dysphagia being 
complete. 
Treatment.-Hypodermic injections of strychnine. 
Patient is nourished by means of the stomach tube. 
February 12th.-The paretic condition on the part of 
the face has almost entirely disappeared, only a slight 
trace remaining at the left labial angle. The arm has 
also regained much of its former strength; the leg, though 
still weak, is also growing stronger, and patient would 
get out of bed and dress himself and sit up. He can 
not stand up yet very well; a tremor comes upon him 
when he makes the effort. The dysphagia is complete 
and persistent. 
Dr. Illoway was called in consultation. This exam- 
ination confirmed the results of the first; the patient 
could not swallow even a few drops of water placed into 
his mouth; it would get down into his larynx and cause 
choking. 
Taking it for granted, from the mode of onset and the 
general appearance of the patient, that the whole trou- 
ble was based upon a syphilitic infection and specific 
disease of the cerebral centres, it was concluded to put 
the patient, in addition to the treatment already insti- 
tuted, upon potassium iodide, 0.75 gramme four times 
daily, administered through the stomach tube, and after a 
few days more to resort to faradization. 
19th.-The patient is improving rapidly. The other 
pareses have disappeared entirely and patient is able 
to go about. He left the house to-day to take a walk. 
The dysphagia still persists. The patient is still fed 
with the tube. 
25th.-The dysphagia is much improved and patient 
can swallow fairly well. A CASE OF CROSSED HEMIPLEGIA. 
3 
Although previously denied, the specific infection 
was subsequently admitted by the patient. 
November 2, 1896.-The status of patient, as just de- 
scribed, has continued. He says that sometimes at 
meals, now, the bolus seems to stick in his oesophagus, 
and then his back is pounded by members of his family 
and he is all right again. 
Some involvement, apparently, of the oesophagus. 
Occasionally, not always, a slight dragging of the right 
leg is noticeable. 
The phenomena, as described, clearly show that we 
had here a case of crossed hemiplegia. This form of hemi- 
plegia is already so well known and its lesions are so well 
described * that nothing more on that point need be 
said here. 
The point of special interest, the unusual feature of 
the case, is the marked and most persistent (in com- 
parison with that of other parts) paralysis of the pharynx. 
That this paralysis was complete was shown by the fact 
that a little water put into the patient's mouth could not 
be swallowed, but caused suffocation, f 
That the case is syphilitic in character there can be 
no question now, as the infection is admitted by the 
patient; furthermore, the mode of onset,J the character 
of the attack, and the results of the specific treatment 
amply demonstrate it. 
1338 Lexington Avenue. 
* Ross. Diseases of the Nervous System. Von Ziemssen's Encyclo- 
pedia. Osler. Practice of Medicine. f Ross. Op. cit. 
$ Ross. Op. cit. Bumstead and Taylor. Venereal Diseases. The New York Medical Journal. 
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