Bilateral First Thoracic Ganglio-nectomy in Two Cases of Parkinsonʼs Syndrome

Abstract

GANGLIONECTOMY IN PARKINSON'S SYNDROME M T BRJNAL MEDICAL¢ JOURNALare most enthusiastic about their greatly increased comfort and happiness, even in the coldest weather; the warmth is most striking and in a paralysed limb seems quite unnatural. The colour has improved markedly in all, but when the patient has been standing for a time there is still a trace of cyanosis, mostly in the calf, showing that in the erect position there is still some lag in the venous return.Although the number of cases is small and but one winter has passed since the operation, yet we think it Likely that sympathectomy will prove of real value-in those cases of anterior poliomyelitis which are subject to recurrent chilblains and ulceration. The results obtained so far have been so entirely satisfactory that they seem to us to justify a more extensive trial of the operation.The CASE I The first case was that of a female Teochew Chinese, aged 28 years. She was admitted to the medical wards of the hospital on February 20th, with a history of having been ill for three months with progressive lethargy and paralysis. On admission she was unable to walk, the knee and ankle reflexes were increased, there was no Babinski reflex, both arms were spastic, and the right hand showed the typical pill-rolling movement. The left hand was spastically contracted, and the lips were tremulous. Cerebration was slow, and fine tremors of the tongue were present.Both fundi were normal, and there was no facial paralysis. There was nothing else of note in any of the systems, and the case was diagnosed as Parkinson's syndrome following encephalitis. In conversation with the physician, Dr. Norris, who was in charge of the case, I suggested bilateral first thoracic ganglionectomy to determine if any improvement could be effected. According to Royle, the result of this procedure is to cut off the sympathetic control from the cerebral vessels, and thereby produce a dilatation of these vessels, thus increasing the blood supply to the brair* The operation is said to produce improvement in Parkinson cases.On March 2nd the patient was operated on under local anaesthesia, according to Royle's technique, and the first thoracic sympathetic ganglion and also the last cervical ganglion, which was fused with it, were removed on the right side. During the operative procedure the patient remained perfectly quiet until the ganglion was picked up by forceps prior to section of the nerve trunks and roots for removal. Immediately the ganglion was compressed the patient called out and the pulse accelerated. It was noted that each time the ganglion was compressed she called out, and when the pressure was removed she remained quiet. Immediately the ganglion was removed Horner's syndrome was noted on the same side. Three hours after the operation the twitchings of the right hand were slower but more forcible and the arm had lost some of its spasticity and was more freely movable.No alteration of the skin temperature on the same side of the face was apparent, as tested by hand touch, the...