In our observations, we were able to note the type of plavix described by Dezherin-Klumpke in only 3 cases. L. T. Zhurba noted the distal type of paralysis of the hand in 26 out of 185 children examined, Kultz and Bly - in two out of 25 children, L. M. Smirnaya and M. M. Pais - in 21 out of 76 children. O. L. Bozhko did not find paralysis of the Dejerine-Klumpke type in any of the 25 observations.
An example of obstetric paralysis of the hand with a predominant lesion of the distal muscles of the hand can serve as our following observation. Patient K., 5 months old, was admitted in connection with complaints of a complete absence of movements in the left arm and a distinct weakness in the right arm. The disease is noticed from the moment of birth. The child was transferred from the maternity hospital to the children's hospital, where he was treated for about a month, but without effect.
Cervical spondylograms show some posterior dislocation of the cervical vertebrae. The nucleus of ossification of the head of the left humerus is reduced in size. According to EMG data, changes are revealed that indicate the interest of segmental structures of the spinal cord. According to REG - moderate vertebrobasilar ischemia is more distinct on the left.
As a result of treatment aimed at the pathology of the cervical spinal cord, a significant improvement was achieved.
This allowed us to assume a bilateral lesion of the motor neurons of the cervical enlargement throughout its entire length, but more severely in the C7-C8 segments. Along with the classical types of obstetricIn the case of regional paralysis, Kerer proposed to single out a total type of paralysis of the hand, where both the proximal and distal parts of the muscles are sufficiently involved in the process.
It is noteworthy that Kerer did not consider it possible to associate such a total type of paralysis of the hand (which, moreover, as a rule, without any disturbance of sensitivity in the hand) with a total lesion of the brachial plexus, but explained its occurrence by detachment of the C5-C6 roots from the substance of the spinal cord. brain or even partial destruction of the cells of the anterior horns at the level of the same segments. Kerer considered cases of total obstetric paralysis relatively rare.