While locomotor ataxia usually develops slowly from gradually increasing causes in the cell structure of the spinal cord, there are cases which develop more or less abruptly with but few, if any, premonitory evidences.
There is a variety due to cellular change in the structure of the brain, which produces disturbances of speech and psychical symptoms in addition to the ataxic phenomena. The commoner form is marked by the presence of various anesthesias and paresthesias without psychical complications. In either case paralysis may be absent or present.
Among those which occur abruptly and unannounced are those which follow certain infectious diseases, such as typhus or typhoid, or diphtheria. Clinically considered these can hardly be distinguished from the ordinary ataxic conditions—tabes dorsalis, but are readily separated by the history and progress of the attack. There is the same peculiar gait, the same characteristic stepping with pounding of the feet and the in-coordination and local anesthesias. The major symptoms are identical in both cases. These acute cases are usually more amenable to treatment, often recovering in a few weeks, or they may enter upon a chronic stage. They are seldom fatal.
I have had under observation for seven or eight years a case which developed in the course of two or three days and at first was rapidly progressive in character. There might have been a psychic element involved in the cause of this case, as there was an operation performed on the rectum without an anesthetic and entirely unexpected and unannounced to the patient. The ataxic symptoms were quite fully developed within twelve hours after the operation and the patient was mentally depressed to an extreme degree.
This case as stated progressed rapidly at first but the progress was finally retarded by treatment and the case assumed a chronic form. There are few cases that received a greater variety of treatment than this had, but I am bound to credit the action of the Roberts-Hawley lymph compound with stopping the progress of the disease and adding five or six years to the life of the patient. This preserved intact, also, the condition of the mind of the patient, enabling him to attend to the details of his business.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.