Remak's Paralysis

REMAK'S PARALYSIS (Remak), a symptom complex identified by Remak the younger, consisting of paralysis of the deltoid, biceps, brachialis, and supinator muscles. In such a pure form, Remak's paralysis is rarely encountered; usually, paralysis of other muscles is added to it, such as, for example, the extensors of the wrist and fingers. Remak's paralysis is more often unilateral than bilateral. In terms of muscle selectivity, Remak's paralysis closely approaches Duchenne-Erb paralysis (see), but differs in the preservation of the scapular and pectoral musculature. Remak's paralysis is flaccid in nature; the paralyzed musculature atrophies and presents various forms of the reaction of degeneration. The arm in Remak's paralysis hangs motionless and lowered; its abduction is impossible, as is flexion of the shoulder; only in a special position can one be convinced of the preservation of the function of the shoulder extensor—the triceps muscle. Sensitivity in Remak's paralysis is usually not affected. Remak's paralysis most often depends on a lesion of the cells of the anterior horns of C5 and C6; in these cells originate the fibers innervating the muscles affected in Remak's paralysis. Sometimes Remak's paralysis is caused by disease of the C5 and C6 roots (see Radiculitis) and in rare cases—the upper section of the brachial plexus. Remak's paralysis is also encountered in lead poisoning; it is possible that here, too, they have a spinal origin. The prognosis in Remak's paralysis is determined by the underlying disease. Thus, it is unfavorable when Remak's paralysis represents a residual phenomenon of a past acute poliomyelitis or syringomyelia, or a tumor of the meninges. The prognosis is significantly better in inflammatory diseases of the roots or plexus. Therapy for Remak's paralysis is successful when it is possible to overcome the underlying disease, for example, syphilitic radiculitis, lead poisoning, or post-infectious neuritis of the plexus. Symptomatic therapy is conducted according to the general rules for the treatment of peripheral paralyses (electrotherapy, massage, thermotherapy). The same E. Remak described a peculiar disease in which paralyses occupy the main place. This is multiple mononeuritis. The clinical picture consists of the simultaneous paralysis of individual nerves, mainly motor ones, located in different parts of the body. Thus, multiple neuritis of the left axillary nerve and right long thoracic nerve, right suprascapular nerve and left musculocutaneous nerve, both facial nerves, and the right thoracic nerve, etc., has been observed. It is understandable that there is no unified symptomatology of multiple mononeuritis: it depends on which nerves are affected. Multiple mononeuritis of motor nerves usually occurs without prodromal phenomena, and paralyses appear immediately, which is how it differs from polyneuritis. In the case of disease of mixed nerves, there are fewer prodromes in multiple mononeuritis than in polyneuritis; the first symptom is usually pain. Nevertheless, between multiple mononeuritis with the scattered nature of its objects and polyneuritis with its characteristic symmetry, there exist transitional forms; such are, for example, bilateral neuritis of the plexuses, bilateral paralysis of the facial nerve. One of the types of Remak's multiple mononeuritis is the multiple cutaneous mononeuritis described by Schlesinger. In it, cutaneous sensory nerves are affected with frequent involvement of branches of the radial nerve. The Schlesinger form can also be symmetrical—for example, bilateral Roth's disease. In the etiology of multiple mononeuritis, various infections, syphilis, and metabolic diseases are noted.