Hodgkin's Disease with Spinal Cord Involvement

tumours of the adrenal medulla and of the sympathetic nervous system as argentaffin tumours. True adeno-carcinoma is less common. It is usually near the proximal end of the appendix, and runs a course similar to that of a carcinoma of the caecum. INTRACRANIAL involvement in Hodgkin's disease has been described on numerous occasions. Spinal involvement is somewhat rarer, although one authority states that fourteen per cent. of all cases of Hodgkin's disease show pathological changes in the spinal cord.l Up till 1931 only forty-three cases had been recorded in the literature, and three more were added in that year by Weil, whose review of the subject appears to be almost a classic. The British literature contains a few references , including one by Carslaw andc Youllg,2 in which Young gives a minute and excellent pathological description of one case. The object of adding one more case to the literature is to draw attention to this complication and to discuss attempts at treatment. J. F., aged thirty-two years, was admitted to the Ards District Hospital on the 22nd March,. 1937, suffering from loss of power of arms and legs of four months' duration, and accompanied by great pain referred to the cervical region and radiating down the right arm. His previous history was that he had been in the Royal Victoria Hospital about three years before with glands in the neck. One of these had been removed, and Hodgkin's disease had been diagnosed. Gordon's test had been done, and this was positive. He had been given deep X-ray treatment and the glands had disappeared. Glands had been found in the axille, and these were also successfully treated with the X-rays. One year ago he had noticed some weakness of his leg, which had improved with X-rays to the back. Paralysis, however, progressed, and the X-rays were repeated without benefit. On examination of the central nervous system, the pupils were unequal; ptosis, enophthalmos, and small pupil were present on the right side; otherwise the cranial nerves were normal. The right arm was paralysed, and the left was very weak. Abdominal and spinal muscles were paralysed, as also were the legs. Anasthesia was present to light touch on the inner side of the hands and arms, and the trunk below this level. Anaesthesia to pinprick also included the outer side of the arm as far as the elbow. Hyperaesthesia was present above the …