1923. No. r6. THE NEl^ROLOGICAL ASPECT OF LEPROSY. 69 



disturbances. Thus one has repeatedly seen common pathological conditions 

 such as paralysis agitans and hemiplegia of vascular origin in leprosy 

 patients. I mention this chiefly in order to point out that one must not 

 regard every neurological manifestation observed in a leprosy patient as 

 due to leprosy. The distinction may be very difficult, as already pointed 

 out in a previous chapter, when speaking of radial paralysis. 



Everything considered, I think we ma}' be justified in saying that the 

 clinical picture of leprosy in neurological respect is entirely due to poly- 

 neuritis. The central lesions, of which the ones of the posterior columns 

 of the cord are the most constant, give such surprisingly little, if any, 

 clinical evidence, that the clinical findings might be said to be in favour of 

 Marie and jeanselme's view, viz. that the cord degeneration only comprises 

 endogenous (myelo-myeliticl fibres. 



If signs of central lesions are thus usually wanting, there are, on 

 the other hand, a number of facts that point not only to a peripheral but 

 to a very peripheral localisation. It ma}^ in fact be said that it is the most 

 peripheral of the leprous lesions that stamp the clinical picture. 



First and foremost the peculiar facial paralysis. The complete atonia 

 in combination with the irregular aftection of individual muscles can, in ni}' 

 opinion, only be explained by the assumption that the lesions are situated 

 in the peripheral branches of the facial nerve. 



The almost entire absence of a motor trigeminal paralysis is also a 

 point in favour of a ver}' peripheral localisation of the lesion. 



On the whole, my observations have led me to conclusions which 

 are very different from Noxxe's. This author regards the clinical picture 

 of leprosv as a mixture of symptoms and signs of peripheral and central 

 origin — and regards the facial paralysis as entirely due to central 

 lesions. 



As regards the "anæsthésie rubanée" described by French authors, I 

 do not believe this to be a true segmental distribution. It never extends 

 to the corresponding parts of the trunk — and is easily explained as due 

 to a predominant aftection of the ulnar and the internal cutaneous nerves 

 of the arm and forearm. 



True, I have found the plantar reflex inverted in two cases; but I 

 have no definite indication that the supposed pyramidal lesion is due to 

 leprosy (cpr. above). Besides, in a disease where the small muscles of the 

 feet are affected to such an extent as they are in leprosy, the inversion 

 of the plantar reflex is not a reliable sign of pyramidal involvment, as I 

 have shown with my assistant Dr. Lossius (cpr. Moxrad-Krohn and Lossius: 

 "Inversion of the plantar reflex due to lesions of peripheral neurons" — 

 Norsk magazin for lægevidenskab 1921, p. 11 1. 



As regards the trophic disturbances, I have already advanced my opinion 

 in the previous chapter. 



