Synonym.—Progressive Spastic Ataxia.
Definition.—A sclerosis of the posterior and lateral columns of the cord, in which the posterior root-zones escape, and the reflexes are retained.
Etiology.—The etiology is not well understood. It occurs in males between the ages of thirty and fifty. It may follow exposure to cold or sexual excesses, or follow an injury.
Pathology.—This is a combined sclerosis of the posterior and lateral columns, beginning in the lumbar region. The nerve-roots, however are not involved, differing from locomotor ataxia.
Symptoms.—The symptoms embrace those of spastic paraplegia and locomotor ataxia, and develop slowly. All the symptoms of spastic paraplegia are present, though the rigidity is not so marked. In addition, in the early stage, the power of locomotion is somewhat impaired; especially if he attempts to turn quickly, he will stumble, or if he attempts to stand with the feet close together, his body will sway, and in the dark or with the eyes shut, he walks with difficulty. As the disease progresses the gait takes on the characteristics of locomotor ataxia, though the stamp is not so forcible.
The reflexes are increased, the knee-jerk being exaggerated, and ankle clonus is present.
Sensory symptoms, especially the lightning pains and crises, are absent, though a dull pain may be experienced in the sacral region.
The Argyll-Robertson pupil is generally absent, and optic atrophy rarely ever occurs.
The sphincters are not usually involved, though menstruation is sometimes difficult.
The ataxia may extend to the upper extremities, and in some cases mental disturbance is pronounced.
[image:14520 align=left hspace=1]Diagnosis.—The diagnosis is generally easy, the incoordination on the one hand, and the exaggerated knee-jerk on the other, show the existence of a combined disorder.
Prognosis.—The disease being progressive, the prognosis is unfavorable as to cure, though the patient may live for years, and death generally results from intercurrent diseases. In some cases the disease is arrested for a time.
Treatment.—The treatment will be along the same line as that for locomotor ataxia.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.