F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
291
CORTICAL CONTROL
Certain cortical areas, especially the sensory-motor cortex but also the precentral area
(field 6), exert some regulatory influence on the sudomotor function. This was concluded
from observations in unilateral cerebral paralysis, Jacksonian epilepsy (Toporkoff, 1925;
Guttmann & List, 1928; Guttmann, 1931) as well as from results of electrical stimulation
of cortical centres and from cortical excisions within the sensory-motor region (Guttmann,
1931). In this connection, the case of one of my patients described in my monograph
on X-ray diagnosis by contrast methods, published in Vol. VII, 2, of the
Handbuch der
Neurologic
of Bumke and Foerster (Guttmann, 1936) may be mentioned, who, apart
from a spastic paresis of the left hand and arm, was suffering from Jacksonian epilepsy,
starting in the extensors of the left hand and ringers and progressing into the whole left
arm. There was distinct sweating of the left hand and forearm during and after the
seizures. The underlying cause of these seizures was found to be a large frontal para-
saggital meningeoma of the right side, which I removed. The tumour reached distally
just into the hand and finger areas of the motor cortex. Following operation the patient
had at first a complete left hemiplegia from which, however, in due course he made a
full recovery, including return of the isolated finger movements of his left hand. For
several days, the hemiplegia was accompanied by outbursts of profuse sweating over
practically the whole left side of the body, and from time to time one could see large
beads of sweat appearing over the left forearm. Toporkoff (1925) described in a patient
an outburst of sweating over the right hand extending to the elbow as aura before an
epileptic attack. Moreover, sweating over that area also occurred as equivalent of seizures
lasting for i hour. Fig. 126 shows one of my patients suffering from Jacksonian epileptic
fits which always started in the hypothenar muscles of the left hand. Thermoregulatory
sweat test showed start of sweating in the left hypothenar, and during the further stages
this man showed a relative hyperhidrosis over the left arm and trunk. Other cases of this
kind have been described previously (Guttmann & List, 1928).
During electrical stimulation of the left sensory cortex by Foerster, in a case of focal
epilepsy manifesting itself by paraesthesia and clonic contractions of the right foot and
leg, I observed during continued stimulation of the left cortical focus for the abdominal
muscles, a clear outburst of sweating confined to the right abdominal region. The sweat
secretion continued for some time after the electrical stimulation had ceased. Following
the excision of the foci for foot, leg and abdomen of the sensory-motor cortex by Professor
Foerster, resulting in spastic paralysis of the right leg associated with sensory disturb
ances up to an area just above the umbilicus, the thermoregulatory sweat test, using
Minor's starch-iodine technique showed earlier onset of sweating followed by hyper
hidrosis in the affected areas. In another patient I excised the left frontal oculo-motor
field (area 8), because of focal epilepsy originating from that area. Following the operation
and also three days later there was distinct though only temporary hyperhidrosis over the
left side of the face. These observations reveal a somatotopic division of the thermoregu
latory centres of the cortex. Penfield & Boldrey (1937) reported that 'perspiration seems
to have occurred once as a result of low precentral stimulation'.
In this connection, experimental studies of Langworthy & Richter (1930), Wang & Lu
