110 ENDOCRINE GLANDS 



DIAGNOSIS. 



The diagnosis of the tetany syndrome is very simple. 

 There is no disease simulating tetany, when the latter is 

 characterized by localized contractures of the extremities 

 occurring at intervals. 



A differential diagnosis has only to be made in the 

 chronic or generalized forms, in which the contractures 

 last for a longer period of time. Tetanus is distinguished 

 from it by the mode of onset of the contractures. The 

 latter begins with the masseter muscles; trismus is an 

 early sign, then comes dysphagia and then contractures 

 of the back of the neck, trunk and extremities. In tetany 

 trismus is missing or only appears late in the disease and 

 the contractures begin with the upper limbs. The 

 temperature is never as high as in tetanus: sweats are 

 absent. Trousseau's sign, Chvostek's sign, and Erb's 

 sign are missing in tetanus. The contractures caused by 

 encephalo medullary organic lesions are permanent and 

 associated with exaggeration of the reflexes and motor 

 paralysis, the spasm affects all the limbs and not only 

 their extremities. 



Hysterical contractures have not the aspect of the 

 evolution of tetany, and have none of the electrical or 

 mechanical signs of the disease. 



Lumbar puncture enables us to differentiate sympto- 

 matic tetany from meningeal affections. 



PATHOGENESIS. 

 RELATION BETWEEN TETANY AND PARATHYROID INSUFFICIENCY. 



We do not yet know the anatomical lesions causing 

 tetany. This disease, which has been believed to be due 

 to rheumatism, a central nervous affection, is at present 

 considered as the expression of a parathyroid insufficiency/ 



