Platybasia

CASE I. (N.H.H. A83,140.) The patient was a 44-year-old white man admitted to the New Haven Hospital on the medical service for the first time in June, 1939, with the complaints of pain in the neck and difficulty in speech and swallowing. The patient datedhis symptoms back two weeks prior to admission at which time he developed an upper respiratory infection. This was followed by the appearance of stiffness of the neck and pain in the upper cervical and occipital regions, particularly upon flexion of the neck. There was gradual development of numbness involving the entire left side of the body, clumsiness and weakness of the left hand, and unsteadiness of gait. At the same time there appeared diplopia and intermittent, generalized headaches associated with some difficulty in hearing. For one week prior to his first hospitalization he had complained of a sore throat and shortly thereafter of thickness of the tongue and difficulty in speech. For four days there had been occasional vomiting and troublesome hiccoughs, not relieved by the usual measures. Investigation into the past history revealed that the patient had suffered from periodic "cramps" of the left hand for about five to six months. These consisted of involuntary contraction of the flexor muscles. There was also a history of easy fatigability for about six to seven months. There was no history referable to trauma to the head or neck. Examination at the time of first admission disclosed a rather dull and apathetic white man who did not appear to be acutely ill. There was a tendency to hold the neck in a flexed position, with definite stiffness on rotation to the right. Palpation of the suboccipital region and over the first three cervical vertebrae elicited pain. Examination of the cranial nerves