ELECTRIC SHOCK TREATMENT SUCCEEDED BY COMPLETE FLACCID PARALYSIS, HALLUCINATIONS, AND SUDDEN DEATH
Case Report with Anatomical Findings in the Central Nervous System
W. RIESE M. D.1, and
G. S. FULTZ M. D.2
1 Department of Neuropsychiatry, Medical College of Virginia, Department of Mental Hygiene and Hospitals, Commonwealth of Virginia.
2 Tucker Hospital, Richmond, Va.
1. The case of a 44-year-old woman is reported who developed a flaccid paralysis of all four extremities with areflexia after her second electroshock treatment. After her fourth treatment auditory hallucinations were noted and soon thereafter she died.
2. Adopting the principles of jacksonian neurology the postparoxysmic, flaccid paralysis is explained by the "exhaustion" of the nerve cells of the highest centers after their excessive, sudden, and rapid discharge. This sudden cessation (functional destruction) of nervous function produces in its turn the remote, widespread, and usually transient effects of diaschisis. The hallucinations are interpreted as the result of the overactivity or release of the healthy parts of the highest centers.
3. On histologic examination the central nervous system showed fatty products in the nerve cells, disseminated through all levels, cellular changes and glial reactions in the frontal areas, seen in serial sections, scattered areas of disruption and "explosive" destruction, assuming stellate and circular shapes, but also mere rents and slits, associated with displacement of the ganglion cells. The assumption is made that the changes described are not specific in themselves but gain their importance in relation to the clinical history of shock, paralysis, and sudden death in a relatively young individual show ing no detectable pathology responsible for the changes observed.
