PABATHYROID GLANDS 



595 



reproduced an illustration of a case of hemitetany described by Cursch- 

 mann in 1910. In this figure the limitation of the spasm to the extrem- 

 ities of one side is clearly visible. 



The duration of the attacks varies much, even in the same individual 

 and at any given period of the disease. Thus, the tonic rigidity may 

 last only a few minutes, say fifteen ; but in 

 the majority of instances the attacks last 

 from one half hour to three hours. Hoff- 

 mann (a) (&) has described a case in which 

 the attack of tonic contracture lasted as long 

 as ten days. 



The exciting cause of the actual attack 

 seems to differ in different cases. Some- 

 times it appears to be emotional excitement ; 

 sometimes, a slight trauma; sometimes, ex- 

 posure to cold, for example, towards 

 morning in bed ; in a few instances the 

 spasms seem to be of the intention type, as 

 in Thomsen's disease. 



The exquisitely tonic character of the 

 contractions is very characteristic of tetany. 

 Occasionally, however, outspoken clonic 

 contractions are met with, and sometimes 

 fibrillary twitchings and tremor. 



Following the seizures, the muscles 

 affected may be markedly paretic; some- 

 times, indeed, paresis seems to occur as an 

 equivalent of a tetany attack,, not only in 

 human beings, but in experimental animals. 

 The paresis of muscles is most often notice- 

 able in the lower extremities. Especially 

 when the patients walk, they exhibit a slow, 

 shuffling, often waddling gait, suggestive 

 of muscular dystrophy. 



Observation has also been directed 

 toward the time of day in which con- 

 tractures appear. Attacks of muscular 



spasm, it would seem, may occur at any time in the twenty-four hours. 

 According to von Frankl-Hochwart's analysis, they occur quite irregularly 

 in some patients; in others there is a predilection for the afternoon, in 

 still others, for the night. Occasionally, a certain type of contracture 

 occurs ri certain hours. 



The prognosis of the single attack of muscle spasm quoad vitam is 

 good. Now and then a patient dies in an attack, though this is very rare. 



Fig. 4. Severe attacks of hemi- 

 tetany of the left arm with in- 

 volvement of the shoulder muscu- 

 lature. The patient is trying, as 

 usual, to stop the painful cramps 

 with his right hand. The left leg 

 is only a little involved. Note 

 the elevation of the knee. (After 

 H. Curschmann, in Deutsches 

 Zeitschr. fur Nervenheilkuride, 

 1910.) 



