PARATHYROID GLANDS 677 



eye muscles, direct the examiner's attention to the basilar meninges. In 

 tetany, the pulse is accelerated; in tuberculous meningitis it is usually 

 slowed and irregular. In meningitis, irregular breathing is observed ; this 

 is unusual in tetany. 



It must be remembered, however, that the tetany syndrome may occur 

 in the course of a tuberculous meningitis associated with general miliary 

 tuberculosis. In one such case, at autopsy, Winternitz (now of Yale Uni- 

 versity) found miliary tubercles in a parathyroid gland ! 



Lumbar puncture should be done, if any doubt about the existence of 

 tuberculous meningitis exist. The film in the fluid, the mononucleosis, 

 and the presence of tubercle bacilli decide the diagnosis. 



Katatonia. The stereotyped attitudes seen in katatonic stupor might, 

 by the uninitiated, be confused with the tonic spasms of tetany. The 

 muscles once innervated in katatonia may preserve their innervation for 

 hours, for days or even for weeks, unintermittently. The head may be in- 

 clined to one side, the legs may perhaps be crossed, the mouth may be pro- 

 jected snout-like, or the thumbs may be turned in. 



But the mental state of the katatonic patient is characteristic (nega- 

 tivism, command automatism, grimaces) and, moreover, the marks of 

 tetany (increased electrical excitability, facial phenomenon, leg phenome- 

 non, etc.) are absent. 



b. Conditions in Which Tonic Spasms that Involve Local Muscular 



Domains Occur 



Facial Spasm. When, in tetany, the spasms are limited to the muscles 

 of the face and of the eyelids, their true nature might easily go unrecog- 

 nized. Scheiber has reported a case in which facial spasms lasting for 

 weeks were due to tetany, though no other spasms were present in the 

 body. The differentiation among the different kinds of facial spasm that 

 may occur is, as Chvostek points out, especially difficult, because clonic 

 spasms of the face may occur along with tonic spasms in tetany. 



Spasm of the Glottis. Laryngospasm is one of the common symptoms 

 of tetany in childhood and may be the only spontaneous tonic spasm exhib- 

 ited. Most tetany children that suffer from laryngospasm also have rickets, 

 and there has been much dispute as to whether the laryngospasm is due to 

 the tetany or to the rickets. It is also known that laryngospasm may be a 

 symptom in organic diseases of the brain (meningitis; sclerosis). The 

 diagnosis of tetany with laryngospasm in children depends upon the dem- 

 onstration of the existence of an increased electrical excitability of the 

 motor nerves. 



Spasm of the Diaphragm. Spasm of the diaphragm is sometimes met 

 with -in tetany, but this form of spasm must be distinguished from asthma 



