Title: PRIMARY SENSORY NEUROPATHY WITH MUSCULAR CHANGES ASSOCIATED WITH CARCINOMA
Abstract: Among the many clinical forms of polyneuritis, one that affects sensory function alone is sufficiently unusual to attract more than passing attention.In milder forms of infective polyneuritis and in unusual post-diphtheritic cases the clinical phenomena may be predominantly sensory, but evidence of muscular weakness and wasting, particularly in proximal muscle groups, can usually be demonstrated.The so-called diabetic ataxia and alcoholic tabes are also not clear-cut sensory disorders.Herpetic zona is not only confined to a single or related group of nerve roots, but is also regularly accompanied by a motor component, -an anterior poliomyelitis, which is more evident if the involved segments supply the musculature of a limb.The syndrome presented below could be classed among the ataxias, pre- senting as it does a severe disorganization of movement.From the first the severity of loss of general sensation, beginning at the periphery of the limbs, advancing to include the trunk, and in one case the face, differentiated the clinical picture from that of tabes dorsalis.The coexistence of imyositis" was not suspected during life.Both patients* were observed in 1939, and though the pathological material has been pre7rved, the part of the clinical record of Case 2 dealIng1ith the last two months of the patient's illness was lost during the war years by the hospital where he was admitted; Sufficient, however, remains from rny personal record of the earlier part of his illness to indicate the identity of the process in the two patients.Case HistoriesCase 1.-The first patient was demonstrated at a clinical meeting of the Royal Society of Medicine on * The two cases presented here are included with one other in a paper by R. Wyburn-Mason on " Bronchial Carcinoma presenting as Polyneuritis," in the Lancet of Feb. 7, 1948, p. 203, which has appeared since the present paper went to press.The detailed pathological analysis reported here does not support the theory of " reflex" production of peripheral neuritic symptoms (in analogy with pulmonary osteo-arthropathy) proposed by Wyburn-Mason.Feb. 16, 1939, by Dr. D. Kendall, and the pathological material from this case was presented by the present author at a pathological meeting of the Society on May 18 of the same year.A boiler cleaner aged 59 years was seen by me at St. Bartholomew's Hospital, London, in December, 1938, suffering from numbness of both feet, both hands, and the face.In his previous medical history the only illness of note was of a carbuncle on the neck eight years earlier.He had occasionally drunk beer, never spirits.He had not been exposed to lead or to any noxious fumes.Since about August, 1938, he had felt generally depressed but not definitely unwell.In early October, 1938, he developed an ache in his right ear radiating into the right side of the neck.After fourteen days he noticed a numbness of the soles of both feet which advanced up the legs a little in the following three days.At this time he first noticed a numbness round his mouth and this gradually spread to involve the whole face in the course of a few days.At the same time the hands were becoming num..The numbness of face, hands, and legs thus rapidly developed in seven to ten days, then remaining fairly stationary.Throughout late Decembes and all January he received thiamine by intramuscular injection.In early January he began to have intermittent tingling sensations in both hands and both feet.In this period he had intermittent stabs of pain in the inner aspect of the ankles and radiating to the knees and buttocks, and the numbness spread up the legs to the knees and up the forearms to above the elbows.On Jan. 20, 1939, he was transferred to the National Hospital, Queen Square, under the care of Dr. Gordon Holmes.He had no headaches, no disturbance of vision, no tinnitus or vertigo, and no dysphagia or dysarthria.There was no disorder of sphincter control.His appetite had been poor for the duration of his illness, but there was no deficiency in diet.He had lost about -30 lb. in weight in the previous six months.His stools had been natural and never tarry.On admission to the National Hospital he was pale and thin but cheerful and co-operative in examination.Vision was unaffected and the optic discs of good colour.Ocular movements were unaffected, and no pupillary 73 B