This case is reported because of its uniqueness and because of the emphasis laid on an important principle in the economy of the nervous system. That is, when the balance between two opposing systems is interfered with by disease, the clinical picture is so modified that it may lose one or several of its characteristic qualities. In this case a parkinsonian syndrome occurred without rigidity of muscles and without the characteristic masklike facies. The presence of lesions in the posterior column as a result of pernicious anemia so decreased the tonic qualities of the neuromuscular system that although a lesion was postulated in the striate system no rigidity was found and the muscles were hypotonic.
From the series reported by Ahrens,1 Weil,2 Wilkinson3 and Woltman4 and the recent article by Goldhamer, Bethell, Isaacs and Sturgis,5 it is agreed that about 80 to 90 per cent
Schwab SI, Schwab RS. PERNICIOUS ANEMIA AND COMBINED SYSTEM DISEASE WITH DIABETES MELLITUS AND PARKINSONIAN SYNDROME: Report of a Case. Arch NeurPsych. 1936;35(1):126–130. doi:https://doi.org/10.1001/archneurpsyc.1936.02260010136011
Customize your JAMA Network experience by selecting one or more topics from the list below.