[Two rare cases of spinal hemiplegia; Brown-Séquard cervical syndrome and Mills' syndrome].
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According to the clinical classification of amyotrophic lateral sclerosis by Hemmer its "hemiplegic type" is described from two observations in 37 personal cases. The peculiar difficulties of differential diagnosis especially with the hemiplegic type of multiple sclerosis in two further cases are discussed in detail. Four cases of "Mills' syndrome" are compared. "Mills' syndrome" has been assumed to be a slowly progressive, unilateral ascending or descending variant of amyotrophic lateral sclerosis. A study of Mills' original papers and evaluation of personal observations leads to a more critical assessment. In Mills' original cases, widely different entities such as multiple sclerosis, syphilis, and parkinsonism are included besides amyotrophic lateral sclerosis. In the light of the investigations presented here, Mills' syndrome seems to be merely an obsolete clinical term.
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Three clinical observations of patients with Mills' syndrome are presented. The clinical peculiarity of the syndrome and the specificity of the pathological process localization in the brain revealed on pneumoencephalographic examination are stressed. The atrophic process in the fronto-parietal parasaggital divisions of the cerebral cortex is regarded as a morphological substrate of the syndrome. A conclusion on the vagueness of the process character and prematurity of the pathogenetic correlations is drawn. Nosological independence of the pathology is not improbable.
We report the case of a 69 year old man who presented hemiplegia with an ascending spread suspected to be a primary form of Mills syndrome. The patient underwent MRI, which showed multiple lacunar infarcts of the periventricular and subcortical white matter. We recommend that patients with a suspected primary form of Mills syndrome should be studied with MRI.
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We describe the case of a 20 year old boy with a giant congenital nevus who developed a chronic progressive ascending hemiparesis. The association of the pigmented lesion with a focal neurological deficit is pathognomonic for neurocutaneous melanosis complicated by a leptomeningeal melanoma. MR imaging at 1.5 tesla ruled out such a possibility and showed a small aspecific pontine lesion along the route of the corticospinal tract. We discuss possible etiologies.
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