CLINICAL SYNDROMES DUE TO DIS- 

 ORDERS OF THE PARATHYROID GLANDS 



LEWELLYS F. BAEKEK 



BALTIMORE 



(a) Tetany > 



I. Introduction 



Tetany is a clinical syndrome characterized by a peculiar hyperex- 

 citdbility of the nervous system (motor,, sensory and autonomic), and, in 

 manifest cases, also, by spontaneous attacks of peculiar tonic spasms, 

 involving certain groups of muscles, or even the whole body musculature. 



The syndrome can be easily and surely recognized, in all cases, by 

 demonstrating the existence of its most constant and characteristic mark, 

 namely increased response to galvanization of the motor nerves (Erb's 

 phenomenon') . 



Clews to the existence of the syndrome include also certain responses 

 of the motor nerves to mechanical stimulation. Thus, pressure on the 

 nerves in the bicipital sulcus gives rise to a peculiar "obstetrical" attitude 

 of the hand and forearm ( Trousseaus phenomenon) ; tapping the facial 

 nerve causes contractions of the muscles on the corresponding side of the 

 face (Chvostek's phenomenon) ; stretching the nerve trunks of the extremi- 

 ties causes peculiar localized contractions of the muscles of these extremi- 

 ties (arm and leg phenomena described by Ferenczi, Pool, Schlesinger 

 and others). 



In the severer cases, tetany manifests itself by spontaneous attacks of 

 intermittent tonic contractions of certain groups of muscles. These spon- 

 taneous tonic spasms are often painful, and tend to be limited to groups 

 of muscles innervated by certain nerves (brachial; lumbosacral), so that 

 in the patients' extremities, definite attitudes (obstetrical hand; extension 

 of knee with extreme supination of the foot; carpopedal spasm) are 

 assumed during the attacks. Though usually bilateral and symmetrical, 

 the tonic spasms may affect one half of the body only (hemitetany) . 

 Cramps may occur also in the laryngeal muscles (laryngosnasm"). in the 

 face and jaw muscles (facial spasm; trismus), occasionally in the tongue, 



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