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way presides over motion and provides for coopera- tion of muscle groups (synergia), and graduates the strength of nerve impulses (eumetria). It regulates the inervation of the trunk, limb, and eye muscles in such a manner as to secure continuous and har- monious maintenance of equilibrium (Bing). The question of definite cerebellar localization has been much discussed. Ferrier maintains that the various segments, particularly of the vermis, have specific function. Rothmann and the Italian neu- viagra opinie rologists support the theory of definite cerebellar localization. Horsley and the English school have not been how much does viagra cost able to confirm these claims. Balk, a Dutch how much does viagra cost comparative anatomist, has viagra opinie worked out a rather elaborate scheme of localization. He appears, at least, to have shown that all areas in the cere- bellum are not of equal consequence; for example, he points out the interesting fact that the spino- cerebellar tracts end in the vermis, and that in animals viagra opinie requiring a high degree of skill in the maintenance of balance the vermis is highly developed. The chief and more characteristic symptoms how much does viagra cost of cerebellar disease may be grouped under four heads : (1) Ataxia (incoordination); (2) hypotonia (re- duced muscle tone) ; (3) astasia (tremulousness) ; (4) asthenia. Asthenia is an viagra opinie inconstant general symptom. Astasia or tremulousness occurs only in unsupported parts on the affected side — it is not a true tremor but rather a tremulous unrest. The sjinptom of chief importance is ata.ria. and without ataxia a diagnosis of cerebellar disease is not justified. Cerebellar ataxia affects chiefly the viagra opinie larger and more complicated movements. Simple movements, such as flexion, extension, abduction, or adduction may be correctly executed. It is the lack of "team work" of the muscle groups, i.e. the lack of synergia that is really characteristic. September 4, 1915] MEDICAL RECORD. 397 Syiiergia implies ttie proper action of opposing muscle groups and of other groups contributing to the performance of movement. Thus, to flex the fingers to the best advantage the wrists must not flex. This cooperation of muscles is imperfect in cerebellar disease. As a result how much does viagra cost of this, inability how much does viagra cost to how much does viagra cost maintain the balance is viagra opinie frequently present. In order to test synergia, viagra opinie Babinski viagra opinie has the patient stand well balanced and suddenly throw back the head. In the event of impaired synergia the patient loses his balance. Another test is rapid alternate pronation and supination of the forearms, or similar tests involving the smaller movements. In case of unilateral cerebellar disease viagra opinie there is marked im- pairment in the ability to viagra opinie perform these movements on the affected side, a symptom which Babinski calls adiadochokinesia. Dysmetria or the failure to judge distances is another evidence of incoordination. For example, a cerebellar patient reaching for an object will frequently overdo the movements necessary in obtaining it. Cerebellar ataxia is not affected by closing the eyes. The more complex a movement is the more likely is it to bring out the ataxia. The typical gait of the cerebellar patient is the "drunken stagger". In unilateral disease, deviation in walking is toward the affected side. The patient may complain of a sense of being dragged toward the side of the lesion; accordingly, in starting to walk he sets him- self with the shoulder of the affected side forward to counteract this tendency. If the patient is on his hands and knees he may present the "corkscrew" symptom. Thus, if the head represents the handle of the corkscrew, a left-sided cerebellar lesion pro- duces the attitude of an ingoing corkscrew. That is the left buttock will be lower than the right. Certain other tests have been elaborated, as, foi- example, Barany's rotation test. Under normal con- ditions, when the patient is rotated rapidly to the left, if he tries to point at an object when the rota- tion ceases he will point to the left of it and have nystagmus to the right. If he has right cerebellar disease he will point more directly at the object and does not have nystagmus. Barany's test of pro- ducing nystagmus by injecting cool water into the external auditory canal is of considerable value. In case of involvement along the viagra opinie vestibular tract the nystagmus does not occur as in the normal subject. Weisenberg has recently effectively emphasized the value of these tests when properly applied, and has well urged their routine use in suspicious cases. Pure cerebellar disease causes no cranial nerve symptoms. Neither does it how much does viagra cost cause a disturbance in reflexes. However, pressure symptoms, producing cranial nerve symptoms and reflex disturbances, may result in cases of cerebellar disease, viagra opinie as in diseases affecting any other intracranial structure. Hypotonus is a rather frequent symptom in cere- bellar disease, inasmuch as the spinocerebellar and cerebellospinal how much does viagra cost tracts are concerned not only in the regulation of muscle movements, but also in the maintenance of muscle tone. Whereas viagra opinie hypotonus in spinal disease is accompanied by reduced reflexes, this is not true in pure cerebellar hypnotonus. It is true, however, that cerebellar growths how much does viagra cost may produce pressure in such a way that there is a marked increase in the pressure of the cerebrospinal fluid so that the posterior nerve roots may be disturlied and reflexes may be diminished. Hypotonus involves chiefly the body and extremities on the same side as