FACIAL PALSY FROM BRAIN DISEASE. 107 



this is often associated with rotation of the head to 

 the right, with right inclination (see p. 151). 



Again, we see that if one hemisphere, instead of 

 being weakened, be excited, causing spasm of the 

 muscles, the head is rotated to the same side as the 

 spasm ; thus the kind of condition of the brain is 

 indicated or expressed by the relative position of 

 the head to the side of the body affected. 



The brain lesion causing hemiplegia does not 

 affect equally all the parts of the upper extremity. 

 On comparing the degree of power of movement in 

 the fingers and in the arm, we find that though the 

 patient can open and close his hand, and carry it to 

 his mouth, still he cannot use the smaller parts of 

 the hand for fine operations ; he cannot pick up a 

 pin off a wooden table, or unfasten the middle 

 button of his waistcoat. He has lost the power for 

 fine adjustments of the small parts, but has still 

 fair power over the limb in its larger parts. 



As to the facial paralysis seen in hemiplegia,* all 

 the muscles on the side of the face are weakened, 

 but very unequally ; there is very slight weaken- 

 ing of the orbicularis palpebrarum. The patient 

 can close his eyes, although not so strongly on the 

 paralyzed side when urged to close them both 

 tightly ; sometimes, especially in chronic cases, we 

 discover no difference on the two sides. This 

 cerebral-facial palsy differs from that due to disease 

 of the facial nerve in its distribution. Brain facial 

 palsy weakens mostly the muscles about the mouth. 

 This is seen markedly when the patient shows his 

 * See Figs. 10, 11, and compare with Fig. 27, p. 202. 



