A case of hemiplegia due to the thrombosis of the right common carotid artery is presented. This would seem to be only the second case reported in the literature as far as could be determined. The underlying aetiology was undetermined and the patient belonged to the group presenting with explosive symptoms. The absence of fundal changes and visual disturbances is noted. The pathogenesis and the clinical features of thrombosis of the carotid vessels are discussed and the possibility that reflex spasm plays a part in the premonitory symptoms and in the productions of the full syndrome is stressed. An unusually high red cell count as a possible factor in the pathogenesis of the thrombosis in this patient is commented upon. The several points in the diagnosis are enumerated and the importance of the palpation of the arterial peripheral pulses in the carotid and temporal regions is stressed. The various aspects of treatment depending on the particular phase of the pathology are considered.
Five cases of unusual paralysis are descriptionbed. The main features were the gradual onset of a flaccid paralysis in the absence of fever with the abolition or diminution of tendon reflexes and no objective sensory or mental changes. In no case were the cerebrospinal fluid cells much increased although, whenever tested, the protein was higher than normal. An interesting feature is the involvement of the pyramidal tract in two of the patients, showing that the infection was not confined solely to the nerve roots. In no instance could alcohol or diphtheria be incriminated, nor was there history of metallic or organic poisoning. In the present state of our knowledge the cases descriptionbed must be classified in the Guillain-Barre group. In the absence of any known factor it may be presumed that this syndrome is due to a virus, but no virus has so far been isolated. Recently a new virus, the Coxsackie virus, which causes a flaccid paralysis in suckling mice, has been considered responsible for a poliomyelitis-like syndrome in America; this is a different virus from the true poliomyelitis virus which affects monkeys. There is good reason to hope that the virus or viruses responsible for the Guillain-Barre syndrome may soon be isolated. In this syndrome, if the patient does not die from respiratory paralysis, recovery is good. -The importance of arranging that an efficient mechanical respirator is at hand at the onset of such paralysis must be stressed; the iron lung undoubtedly saved the life of one of the cases descriptionbed. Vitamin B12 might be tried, and the new antibiotics Aureomycin and Terramycin. Muscle spasm does not appear to play any part. Physiotherapy is beneficial in hastening the return to normal movement. As yet there is no known specific treatment.