The literature on the subject of spinal‐cord compression in Paget's disease including its association with a paravertebral mass is reviewed. This mass is thought to be a pseudocallus and is an attempt on the part of the diseased bone to stabilize its structure and is seen at sites in the vertebral column where the disease process is most active. The symptoms including girdle pains are relieved by laminectomy. A decompressive laminectomy is indicated in the treatment of these patients and produces good results.
Entrapment of the median and posterior tibial nerves in the carpal and tarsal tunnels, respectively, in Paget's disease, are described. In each, decompression resulted in a complete relief of sensory symptoms. Factors in the genesis of selective wasting of the thenar pad are outlined.Deformity of hone is a characteristic feature of Paget's disease. This is associated with an alteration in the texture and internal architecture of bone and consists microscopically of bone showing irregular cement lines and crenated o r scalloped edges flanked by osteoclasts. The marrow spaces arc often filled with loosely textured fibrous tissue. Occasionally there may he a laying down of pagetoid bone (pseudocallus), in relation to a diseased vertebral body (Direkze & Milnes 1970). In such states the circumferential of narrowing of the spinal canal leads to a compression of the spinal cord and the nerves in their course within the spinal canal. Deformity of long bones such as the radius or the tibia as a result of Paget's disease may lead to a compression of the median and posterior tibial nerves in their course within the carpal and tarsal tunnels, respectively. This paper reports two such cases. Case historiesCase I . M.W., female aged 68 years, presented with numbness and tingling in thc distribution of the median nerve supply of the right hand of 2 years duration. Her symptoms were made worse by household duties. This 2 year period was punctuated by episodes of excruciating pain confined to the hand lasting 2-3 days, symptoms being usually worse at night. There was no history of neck pain, sensory symptoms referable to the othix-limbs or difficulty with sphincter control.Clinical examination showed a marked deformity of the right wrist, wasting and weakness of the abductor pollicis brevis and impairment of pain and touch in the distribution of the median supply of the right hand. The reflex pattern in the limbs was compatible with cervical spondylosis. The pIantar responses were flexor.Znuestigations. The haemoglobin, sedimentation ratc, plasma proteins and serum calcium were normal. The alkaline phosphatase was 298 ILA. units. Radiology showed Paget's discase of the pelvis and the right radius (Figure 1 ) . The cervical spine showed narrowing of the C5-6 disc space. The skull mas normal. 24'
A report on a patient who developed profuse fasciculations following diphenylhydantoin therapy for 30 months with subsequent complete recovery on cessation of therapy is presented. In view of the considerable variability of spontaneous potentials generated in spinal motor neurones, in vitro studies and pathological states with respect to shape, amplitude, frequency and duration, caution is advised in the assessment of the clinical significance of fasciculations. The possibility that our patient represents an instance of a ‘reversible form of motor neuron disease’ is entertained.
46XY, normal male karyotype (G-banded) was noted in each patient with progressive external ophthalmoplegia. Although vacuoles have been recognized in other conditions, their presence in significant numbers in the diseases under scrutiny suggests the possibility of a common offending agent. It is likely that vacuolation is a pathological indication of infection by slow viruses.
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