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66
ACUTE POLIOMYELITIS

dizziness which he thought was of bulbar pontine origin. The following figures may serve to show the frequency of cranial nerve affections. Medin found among 64 or 65 cases, nine cases of involvement of the facial, in three of which no other symptom of the disease was present. Paralysis of the hypoglossus was noted in five cases, and, of the abducens, in six. The accessorius was implicated in four cases, the oculomotorius in three, the trigeminal in one, and the vagus in two.

During the Swedish epidemic of 1905, I collected the following figures:

Cranial Nerve Affections 

Associated with Spinal Cranial Nerves Nerve Affection. Alone Affected. VII 12 14 XII 9 9 Eyes 5 3 VI 4 2 III 4 2 IX-XI s 4 V 2 — II ; J.^.Vv> I — 42 34

As shown in this table 42 different paralyses occurred in 34 patients; the 34 affections of cranial nerves, alone, occurred in 22 patients (vide page 63); therefore, it is evident that in a number of patients paralysis of the cranial appears in combination with paralysis of the spinal nerves. Leegaard in 311 cases of paralysis twice found the facial alone implicated (0.64 per cent.) and thrice, facial combined with spinal paralysis; once ptosis appeared associated with an affection otherwise confined to the spinal cord. Ed. Müller observed no fewer than 13 facial and 3 unilateral abducens palsies among 100 cases, but he detected no implication of the other cranial nerves.

Zappert collected 25 instances of combined cerebral and spinal nerve affections out of about 290 cases. During the Austrian epidemic, cases occurred in which only the cranial nerves were attacked, but with reference to these Zappert gives no exact figures. Spieler gave a more detailed report upon 44 such cases from this epidemic. Cranial nerves were involved in twelve cases, the facial in eleven, hypoglossal in five, the oculomotor in two. and the vagus in two. Bulbar disturbances of speech occurred;