We have remarked above that influenza frequently begins in children with an eclamptic seizure, and very rarely in adults with typical epileptiform attacks combined with total unconsciousness and succeeding stupor (van Deventer, Ruhemann, and others). We will now consider those cases in which, directly following the influenza attack, a typical but chronic epilepsy develops, with seizures occurring in short or long intervals. Such cases have been reported by us, by von Landgraf, Jaccoud, van Deventer in the German army Teports, and in many official or collective investigation reports. So far as we know of these cases, they all, after a longer or shorter time, ended in recovery. At least we know of no recorded case in which permanent epilepsy followed influenza, although the occurrence is not thereby excluded. A case reported by us of epilepsia gravissima post grippalis may be mentioned here.*
R. B., male, seventeen years of age, of robust stature and previously healthy, who had never had epileptic attacks, passed through a moderately severe attack of influenza without complications at the end of December, 1889. In the middle of January, 1890, he was suddenly seized with "a convulsion and unconsciousness." These typical epileptic attacks increased in frequency and intensity from day to day. Finally, 10 to 25 attacks occurred in one day. The history of the case was carefully kept from day to day. There was marked traumatic glossitis, but with the increased frequency of the epileptic seizures the whole clinical picture assumed a character different from that of ordinary epilepsy. In particular, during the intervals between the attacks, there were psychic disturbances, confusion, maniacal conditions, during which the patient indiscriminately struck about him, bit, and spoke irrationally. Then came intervals in which the patient was quite rational. Finally, the epileptic attacks increased in frequency and persisted in intensity, the maniacal periods became more acute, and we were obliged to send the patient to the State Lunatic Asylum. He made a complete recovery.
* Our influenza lectures, p. 32.
In addition to epilepsy, many other forms of convulsions and disturbances in movement were observed during influenza or thereafter. Many of these observations recorded in literature deserve fuller mention, but we must content ourselves here simply with their enumeration.
We ourselves described* as a sequel of influenza certain peculiar clonic tonic muscular spasms of the whole body, sometimes producing even tetanic rigidity. Tetanoid spasms of the fingers, with curious spasmic positions, occurred both in the upper and in the lower extremities. Hysteria could be absolutely excluded. Flatten has oberved a similar case. Revilliod and Determann report cases of tetany, the latter observer from Erb's clinic. Cases of pronounced tetanus, sometimes with trismus, have been observed by Revilliod, Milner, Franklin-Churc house. Doubtlessly the cases of tetany which occur at the acme of the influenza attack, without other grave cerebral or spinal symptoms, are to be considered as "toxic tetany," analogous to uremic tetany.
A remarkable case of tremor spasm of the left arm, combined with contracture of its muscles, is reported in detail by the German army report. We observed a case of peculiar tremor paralysis of the left arm with partial anesthesia. Recovery occurred after several months. The patient was a robust laborer in whom hysteria could certainly be excluded. Cases of "typical paralysis agitans," sometimes confined to one arm or one leg, are reported as direct sequelae of influenza in the German collective investigation and also in reports of the Amsterdam Hospital (Bossers).
Other varieties of more persistent tremors affecting either the entire body (Hirschfeld, Wescher, Bidon) or only one extremity (Billaud) are reported in literature.
Influenza has repeatedly given rise to the occurrence of typical chorea. Such cases have been observed.by Rosenstein, Leyden, van Deventer, Demme, Villard, Eichhorst, and others. Typical post in fmenzal chorea we have observed in three cases in children ** and once in an adult. Further there have been reported as sequelae of influenza severe spasm of the glottis (Revilliod, P. Mejes) and spasms of the diaphragm (Kapper), and singultus of eight days' duration (Swiss reports).
Many reports in the literature regarding epileptoid tetanoid spasms, contractures, and diverse varieties of tremors may have been due to hysteria.
In alcoholic subjects influenza, like every other febrile disease, predisposes to delirium tremens. The assumption that influenza, as a rule, on account of its marked neurotoxic character, is relatively more frequently accompanied by delirium tremens than any other acute infectious disease, is quite unfounded. Certainly influenza, with its generally slight fever and its short duration, gives rise to delirium tremens less frequently than the ordinary croupous pneumonia and other acute febrile infectious diseases, such as erysipelas, septicemia, and tonsillitis. The increased frequency of delirium tremens during influenza, as reported by many hospitals, is an absolute increase due to the enormous morbidity of influenza and especially to the frequent occurrence of influenza pneumonia.
* Influenza lectures, p. 28.
** Influenza lectures, p. 28.
The number of patients with delirium tremens admitted into the Charite Hospital in Berlin during the month of December, 1889, was double that of the previous year, and the mortality increased from 6 per cent, during 1888 to 28 per cent, at the time of the pandemic. This enormous mortality is due to the fact that among these delirium tremens patients there were numerous cases of influenza pneumonia. On the other hand, it remains a fact that delirium tremens patients attacked by influenza may, although powerful individuals in the prime of life, succumb occasionally at the height of the influenza attack and the delirium with manifestations of cyanosis and edema of the lung, while the postmortem examination shows nothing but the most intense pulmonary and cerebral hyperemia, with no gross changes in the organs, and in particular no pneumonia. Van Deventer has also called attention to such cases. The frequency of alcoholic delirium during influenza periods is noted on all sides (Rosenbach, Nagy, Bruns, and others). In the Rotterdam hospital more cases of delirium tremens were admitted during the eight week pandemic period (1889-1890) than otherwise during a whole year (Bossers).