Nervous and mental diseases . Fig. 175.—A mixed case Bhowiug facio-scapulohumeral involvement, peroneal wast-ing, and the foot deformity of Friedreichsdisease. There were fibrillary twitchings andthe reaction of degeneration in the leg muscles. 410 DISEASES OF THE CORD PROPER. the lower border of the pectoralis, and the lower part of the deltoids.The serratus magnus, erector spinse, and humeral muscles commonlysuffer early. The myopathic facies is not well marked, but can bedetected in late cases. The forearms, hands, and feet are commonlyspared until the last. The enlarged muscles finally shr
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Nervous and mental diseases . Fig. 175.—A mixed case Bhowiug facio-scapulohumeral involvement, peroneal wast-ing, and the foot deformity of Friedreichsdisease. There were fibrillary twitchings andthe reaction of degeneration in the leg muscles. 410 DISEASES OF THE CORD PROPER. the lower border of the pectoralis, and the lower part of the deltoids.The serratus magnus, erector spinse, and humeral muscles commonlysuffer early. The myopathic facies is not well marked, but can bedetected in late cases. The forearms, hands, and feet are commonlyspared until the last. The enlarged muscles finally shrink, and presentall the features of those that shrink from the first.. Figs. 176, 177, and 178.—Case of the neuritic variety of family progressive myopathy. The peroneal or leg variety, sometimes called the Charcot-Marie type, or the neurotic form, is marked by the early atrophic shrinking of theperoneal muscles. The calves are next involved and the thighs follow.The disease may thus be confined to the lower extremities for years.Eventually it invades the trunk and upper extremities, first affectingthe hands. It shows fibrillar twitchings, the electrical changes ofdegeneration, and presents undoubted cord-lesions. The juvenile type of Erb, also called the brachial form, affects mainlythe muscles of the arms and shoulders, and appears in early youth, andusually in several members of the same family. The facioscapulohumeral form, or the type of Landouzy-Dejerine, affects face, shoulder, and arm, or may be considered as the brachial LESIONS AND DISEASES OF SPINAL GRAY. 411 form plus facial involvement. These cases furnish marked instancesof the myopathic fac