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Article
March 13, 1920

HITHERTO UNDESCRIBED SIGN IN DIAGNOSIS OF LETHARGIC ENCEPHALITIS

JAMA. 1920;74(11):735. doi:10.1001/jama.1920.26210110003007b

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Abstract

While there is no great difficulty in arriving at a diagnosis in the cases of encephalitis presenting a history of double vision, ptosis and other cranial nerve phenomena, a not inconsiderable number of patients are encountered in hospital practice who are brought in unconscious or delirious, and from whom no such history is obtainable. In such instances the patient presents a picture closely simulating that of one in the third week of typhoid fever. There are no focal symptoms pointing to a local central lesion. The leukopenia, so frequently present, is also strongly suggestive of typhoid fever.

In children the picture is almost identical with tuberculous meningitis. I have noticed in the majority of cases of encephalitis a sign that is very startling when recognized. It consists of a rhythmic convulsive twitching of the muscles of the abdomen in the neighborhood of the eighth and ninth ribs. It often simulates

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