This seems to be a remarkable case of psychic disturbance coincident with a progressing disease of the paleo-striate system, and complicated by involvement of the pyramidal tracts. He exhibits a universality of clinical manifestations that is probably unique in a single patient; but this only serves to emphasize the diffuseness of the pathological process that involves corpus striatum lesions in general, and the extent to which it is capable of progressing in a particular subject. But his case is sufficiently atypical to be classed apart from any known disease-grouping, leaving us the alternative of two or more independent diseases affecting the same patient, or a gradual and extensive march of a morbid process that few victims of the pallidiæ class live long enough to undergo. As we shall show, our case has points of comparison with the bilateral athetosis that Cecil Vogt described; with the progressive lenticular degeneration of Kinnier Wilson; with a lesion in the strio-rubral and strio-cerebellar paths and more markedly with the Westplial-Strümpell “pseudo-sclerosis” syndrome. Added to this are evidences of a bilateral internal capsule involve ment, and an extending lower motor neuron lesion in the cord, judging from the asymmetrical bilateral results noted clinically. As is usual with these neo-striate groups, the mental and emotional disturbances are significant (perhaps indicative of some thalamic involvement)—indeed, in this case largely preceding the onset of other signs. Further, the vegetative nervous system also shows its expected hyperactivity (as instanced by most of the reported cases), possibly from an irritation of the subthalamic centres for the sympathetic. A few anomalous trophic disturbances complete the collective picture, of which, from its rarity, a detailed description may not be out of place.
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