PAEATHYEOID GLANDS 621 



9. Tetany and Myotonia 



Myotonic symptoms have often been met with in patients exhibiting 

 the tetany syndrome; but the tetany in such patients has often been 

 atypical and there has been much discussion as to the exact nature of 

 the relationship existing between the tetany and the myotonia. 



Yon Frankl-Hochwart observed myotonic phenomena in the tetany of 

 a patient who, later, was found to have syringomyelia. Myotonic symp- 

 toms are by no means uncommon in syringomyelia, and Schlesinger has 

 even described a "myotonia syringomyelica." Important papers on the sub- 

 ject have been published by Lundborg (&), Bartels, Erb, and others. 

 Cases have been reported in England by Eisien Eussell and in the United 

 States by Jacoby (1898). An extensive collective review of the whole 

 subject of the relations of tetany and myotonia, with reports of cases 

 personally observed, has been made by von Orzechowski (1909). 



Of the myotonic symptoms most often observed in certain cases of 

 tetany, in addition to subjective complaints of stiffness when starting 

 to walk, may be mentioned (1) intention spasm on opening and closing 

 the mouth (masseter muscles) and on opening the fists, (2) general in- 

 crease of muscular excitability, (3) sluggish contraction of the muscles, 

 (4) spasm on opening and closing of the eyelids, (5) stiffening of the 

 hands on immersion in cold water, (6) familial character of the malady, 

 and (7) onset at puberty. 



On analyzing critically all of the cases that had been reported, von 

 Orzechowski arrived at a number of interesting conclusions, among them 

 the decision that the myotonic syndrome met with in certain cases of 

 tetany is, in the mechanism of its origin, entirely independent of the 

 principal symptom of tetany, which is the general increase in the excita- 

 bility of the motor nerves. In cases of tetania myotonica it is exceptional 

 to find a complete syndrome of tetany along with a complete myotonic 

 syndrome. 



The cases in the literature of tetany combined with myotonia. can, 

 according to von Orzechowski, be divided into three groups : 



A. Complete tetany syndrome with single myotonic symptoms. 



B. Formes frustes of tetany with formes frustes of the myotonic 

 syndrome. 



C. Well developed myotonia with single tetany signs. 



The endocrine relationships of tetania myotonica are difficult to 

 unravel. The fact that, in tetania myotonica, either the tetany syndrome 

 or the myotonic syndrome is usually incomplete depends apparently upon 

 an antagonism of the symptoms of the two categories, each set tending to 

 suppress the other. Von Orzechowski suggests that in these combined 

 cases of tetany and myotonia we have to deal with a dysparathyrosis 



