Aside from their occurrence in cases of encephalitis, combined clinical syndromes of the pyramidal and extrapyramidal systems are rare. Lhermitte, Cornil and Quesnel1 described a syndrome based on a case in which the symptoms of pseudobulbar palsy were associated with extrapyramidal rigidity. Claude and Alajouanine2 reported a case that was similar, but in which Babinski reflexes could not be elicited, while the lower extremities were too rigid to permit walking. Lhermitte and McAlpine3 reviewed these cases and the syndrome of Lhermitte, Cornil and Quesnel and presented a somewhat similar case of what they termed a new syndrome that differed from the foregoing in several apparently essential features, notably in the absence of the syndrome of pseudobulbar palsy and in the presence of an additional symptom—choreiform movements. Jakob4 stated that, in cases of cerebral arteriosclerosis, he frequently had seen combinations of partial pyramidal and extrapyramidal lesions.
NIELSEN JM, WILSON DC, DIETERLE RR. PYRAMIDOPALLIDAL DEGENERATION SYNDROME DUE TO MULTIPLE SCLEROSIS: A CASE PRESENTING SPASTIC PARAPLEGIA BELOW THE WAIST AND PARALYSIS AGITANS AND ASTEREOGNOSIS ABOVE. Arch NeurPsych. 1929;22(1):45–54. doi:10.1001/archneurpsyc.1929.02220010048005
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