PARALYSIS OF NECK MUSCLES IN POLIOMYELITIS

By P. N. LAIIA, m.d.

Lecturer in Diseases of Children, Medical College, Agra

Introductory Paralysis of one or both legs is the usual

legacy of acute anterior poliomyelitis. But the

distribution of the motor loss varies within the widest limits. The paralysis may affect any muscles of the body (Collier, Adie and Walshe, 1941). According to Sheldon (1940), isolated

groups of muscles may be involved. Neck

muscles often share in ascending or generalized syndromes, but may be involved by themselves

(Wilson, 1940). Agius, Bartolo, Coleiro and

Seddon (1945) report about their study of 426 cases of poliomyelitis in the Malta epidemic (1942-43). Almost all the cases were in

children under the age of five years but none

showed paralysis of neck muscles. Bernstein, Clark and Tunbridge (1945) give an account of acute anterior poliomyelitis among service

personnel in Malta. The number of cases in

this series was 57 but in none among them was involvement of neck muscles. The appended table (table I) is given by

Lovett (1916) for the New York epidemic of 1916.

Table I

Distribution of paralysis in 1,166 cases

Group Number of

cases

Both legs One leg Both legs, both arms Both legs, one arm One arm Homolateral arm and leg One arm, one leg opposite .. 29 Both arms .. .. 33 Both arms, one leg .. 20 Girdle cases .. .. 57 Facial alone .. .. 38

338 302 127 101 83 38

Wernstedt's (Wilson, 1940) summary of the distribution of paralysis is tabulated below :?

Table II

Summary of paralysis

Localization Number Percentage

Leg .. .. .. 4,519 78.6

Arm .. .. .. 2,372 41.3

Trunk .. .. .. 1,601 27.8 vf

Cranial nerve .. .. 767 13.3

Throat and neck .. .. 333 5.8

From the tables appended above it is clear

that paralysis of the neck muscles in polio- myelitis is extremely rare. Below is reported a case of poliomyelitis in which the neck mus- cles and one arm were involved together.

Case report

N? 2 years, Muslim female child, was admitted to

the Children's Ward with the complaints of inability

558 THE INDIAN MEDICAL GAZETTE [Nov., 1945

to hold the neck erect, and diminution of motor power of the right arm, duration 15 days. The onset was

after an attack of fever which lasted for 3 days._ On examination.?Temperature, pulse and respiration

rates normal. The child could not keep the head erect on the neck. Power to extend the head_ was totally absent; the head dropped forward, causing a

peculiar attitude, which was associated witli_ overaction of the frontalis. The lower cervical spine looked

unduly prominent when the head dropped forward.

The motor power of the right arm was diminished, and there was loss of biceps and triceps jerks. Sensations

could not be tested. There were no fibrillary contrac- tures anywhere in the body. There was no other

abnormality anywhere nor in any other system. Investigation.?Blood : total red cells 4,500,000; total

white cells 11,000; haemoglobin SO per cent; poly- morphonuclears 49 per cent; lymphocytes 48 per cent; mononuclears 2 per cent; and eosinophils 1 per cent; W.R. negative. Urine and stool normal. X-ray of the cervical spine revealed no abnormality.

Progress end treatment.?An adequate dosage of vitamins including B<i and E was given to the child for 2$ months. Gradually the paralysis of neck muscles disappeared and the child could extend the neck, but the paralysis of arm showed no improvement at all, and moreover the arm looked wasted.

Comments

The interest of the case lies in the paralysis affecting the neck muscles which, as pointed out before, is a rare occurrence in poliomyelitis. Out of about 300 cases of poliomyelitis coming under the author's observation during the last 3-|- years at Agra, this is the first case in which the neck muscles shared in the paralysis. The muscles involved were the muscles of the back of the neck, the splenius, complexus, etc.

It is difficult to say how far. vitamin therapy helped in the disappearance of the paralysis of the neck muscles. The fact that no improve- ment occurred in the paralysis of the arm

stands against the beneficial value of vitamin therapy. The author feels that the regaining of power of the neck muscles probably would have occurred even if no vitamins were given. My thanks are due to Major-General H. C. Buckley,

M.D., f.r.c.s., c.s.i., i.M.S., Principal, Medical College, and Superintendent, Thomason Hospital, Agra, for his kind permission to publish the report of the case.

REFERENCES

Aoius, T., Bartolo, A. B. M. J., i, 759-762. E., Coleiro, C., and Seddon, H. J. (1945).

Bernstein H G. G? Ibid., 763-707. Clark, J. M. P., and Tunbridge. R. E. (1945).

Collier, J., Adie, W. J., Price's Textbook of the and Walshe, F. M. R. Practice of Medicine. (1941). Oxford University Press

London, p. 1571." Lovett. R. W. (1916) .. The Treatment of Infantile

Paralysis. P. Blakiston's Son and Co., Philadelphia.

Sheldon, W. (1940) .. Diseases of Infancy and Childhood. J. and A. Churchill, Ltd., London.

Wilson, S. A. IC. (1940). Neurology, 1, 234. Edward _[ Arnold and Co., London.