Non-Alcoholic Polyneuritis associated with Korsakow Syndrome.

Abstract

Case 1.-Patient D.D., at. 25, married, was admitted on January 15, 1934. The history given was that the patient had had one pregnancy which was uneventful. She became pregnant for the second time, and during this pregnancy suffered from cedema, albuminuria and raised blood pressure. Partly owing to these symptoms and partly owing to the fact that the presentation was a breech, labour was induced on October 4, 1933, at another hospital. The labour was difficult, and almost immediately patient developed a temperature of 1030 F. as a result of pelvic infection. This lasted until November 14, when the temperature subsided and she appeared to be progressing favourably until the middle of January, 1934. At this time, she became confused, emotionally unstable, and restless, and was transferred to the Maudsley Hospital. On admission, she was elated and euphoric, said everything was lovely and addressed everyone as ' darling.' She talked in a rambling manner, was restless, confused, and disorientated. She was also incontinent of urine and fieces. Physically she was thin and ' drawn ' and complained of pain in the left leg. The quadriceps on both sides together with all the muscles below the knees was paralysed. The paralysis was of a flaccid type and was more complete on the right than the left side. Patchy anaesthesia to pinprick was present up to the level of the umbilicus, and sensation of touch, temperature, deep pressure and joint sense was abolished in both feet, more so on the right than the left side. She also complained of paresthesie in the form of ' pins and needles' in both feet. The left leg was swollen and cedematous. There was a zone of hyperaesthesia to pinprick present at the level of the umbilicus. Fine horizontal nystagmus to both sides and some slight weakness in the arms were present. The deep reflexes in the legs were completely absent and were markedly sluggish in the arms. A blood count showed 3,745,000 red cells with a colour index of 0-75 and slight anisocytosis and poikilocytosis, the white count being normal. The pelvic organs revealed nothing abnormal. A few days after admission she developed copious diarrhoea with as many as 20 stools a day. The blood pressure was low (86/50) and tachyeardia was present. Repeated bacteriological examination of the stools was negative. The diarrhoea persisted until February, 1934, and until then she was given intravenous salines and glucose. At this time she complained of paresthesia in the hands and the pulse rate had risen to 130. Mentally she remained confused and disorientated and at times was noisy and restless. In addition confabulation was present. A blood count at 21'3