region, and always worse at night. Sore, stiff feeling in neck; at
times nausea and vomiting. Trembling {1073} of left hand; later,
paresis. Two sorts of movements of left arm—one, a fine tremor; the
other, attacks of jerking. Paresis of left arm increasing, with some
contracture; slight paresis of left leg. Sight failing; later,
semi-stupor; pupils small and fixed, the right larger. Right internal
rectus weak. Left lower face paretic. Strong contractures of left arm
and hand. Good knee-jerk. Choked discs. Some days bright, others
almost moribund. Case advanced to complete paralysis of left arm and
leg; involuntary evacuations; divergent strabismus and ptosis;
indistinct speech; delirium and coma.
Pathology and Location: Alveolar carcinoma.
An ovoid tumor in the upper part of the ascending frontal convolution
and in its subjacent white matter. It extended well across the fissure
of Rolando.
Remarks: E. C. Seguin, _Opera Minora_, p. 495, and _Journal of Nervous
and Mental Disease_, vol. viii. No. 3, July, 1881.
19. Sex and Age: M. 50.
Clinical History: History of syphilis and severe fall on the head.
Vertigo. Prickling sensation in left foot, extending to thigh, finally
to arm and head, followed by unconsciousness and convulsion. Stupor
after convulsion. After this, convulsive attacks at intervals.
Eighteen months before death an apoplectic attack, in which was
unconscious for several hours. Spasmodic attacks, preceded by a
peculiar twisting of the fingers of the left hand. Paresis of the
right hand and arm. Some diminution of sensation, not well made out.
Slight want of use of the left leg.
Pathology and Location: Gumma.
One-third of an inch in thickness at the middle of the ascending
frontal convolution. Membranes fused; tumor adherent to them. Œdema of
the brain. Gumma in the lungs.
Remarks: H. C. Wood, “Proceedings of the Philada. Neurological
Society,” _Medical News_, vol. xlviii. No. 9, Feb. 27, 1886, p. 248.
20. Sex and Age: M. 59.
Clinical History: Gradual loss of speech—aphasia. Gradual paralysis of
right side. No headache prior to this. No anæsthesia. Taste, smell,
hearing, and sight intact. Apathetic face. Middle branch of facial
nerve paralyzed, especially the muscles of the right corner of the
mouth. Wrinkles of forehead less strongly marked. Right upper and
right lower extremity in strong contracture. Leg swollen. Increasing
torpor of bladder. Normal electrical reactions, except speedier and
increased reaction of the right facial nerve. Reactions of
convulsibility in the right arm with ten to twenty cells. Very late,
unconsciousness and paralysis of bowels and bladder.
Pathology and Location: Myxo-glioma.
In front of the left ascending frontal convolution, bounded below by
the Sylvian fissure and the upper convolution of the island of Reil;
seems to immediately enter into the structure of the island. Left
optic thalamus and corpus striatum moist, but completely separated
from the tumor. Convolutions flattened.
Remarks: Petrina, _op. cit._
21. Sex and Age: M. 35.
Clinical History: Had epileptic fits for two years before his death.
Occasionally the spasms began in the left half of the face and
extended to the arm and leg, but did not become general. After such
attacks sensation was lost in the left arm, and the arm was paretic
for some hours. Toward the close of life the paresis became permanent,
and extended from the arm to the leg, and sensibility was somewhat
impaired in these limbs. The temperature was 2.5° F. higher over the
right parietal eminence than over the left.
Pathology and Location: Gumma.
Arising from the membranes, two inches in diameter, but very thin,
involved the gray matter of the posterior extremities of the first and
second frontal convolutions, the upper and middle thirds of the
ascending frontal convolution, and the adjacent border of the
ascending parietal convolution of right hemisphere.
Remarks: F. H. Martin, _Chicago Med. Journ. and Exam._, vol. xlvi. 21.
22. Sex and Age: F. 57.
Clinical History: After excitement lost consciousness. Paresis and
heaviness of the right upper extremity. Aphasia; used words
inaccurately; short of words and enunciation impaired. Second attack
of loss of consciousness. Twitching in right half of body and face.
Paralysis of right upper extremity. Severe pains in right arm and leg.
Another attack of loss of consciousness, with spasms of right half of
body. Right lower extremity and right lower face paretic. Slight
trismus; right masseter contracted. Dull headache. Organs of sense not
affected. Understands all that is said to her, although aphasic.
{1074} Sensibility good. Right-sided pneumonia; œdema of lung.
Pathology and Location: Fibro-glioma.
Tumor size of fist occupied the whole of the lower and middle portion
of the parietal lobe, imbedded in both ascending convolutions.
Ascending frontal convolution pushed aside; the annectant gyrus and
island of Reil compressed and flattened. Fissure of Sylvius arched
over by tumor. White substance also pushed toward the corpus striatum.
Meninges congested. Left parietal bone somewhat excavated.
Remarks: Petrina, _op. cit._
23. Sex and Age: F. 39.
Clinical History: Began to suffer with epilepsy two weeks after a blow
on the left parietal region. The fits were preceded by formication in
the right hand and tongue, and began with spasm in the right hand,
which was weak for some hours afterward. A permanent right facial
paresis developed one month after the blow, and two months later the
tongue, arm, and hand were also paretic on the right side. Disturbance
of vision due to choked discs had developed, and temporary attacks of
aphasia occurred after the frequent convulsions. She sank into a
condition of stupor and aphasia four months after the first symptoms.
The skull was then trephined at the seat of the old injury in hopes of
evacuating a chronic abscess, but no pus was found. One week after
this she died.
Pathology and Location: Gumma.
A gumma one inch in diameter was found on the surface of the left
hemisphere, at the junction of the middle and lower thirds of the
ascending parietal convolution, and involving also the convolution
posterior to this. The membranes were adherent to the gumma.
Remarks: H. B. Sands, _Med. News_, April 28, 1883.
24. Sex and Age: M. 25.
Clinical History: Four years previous to death had received a blow on
the left side of the head. A year later, twitching in the tongue and
the left side of the face. Twitching of the left arm. Twitching
increased. Paroxysmal spasm and general convulsions, with loss of
consciousness. Paresis, and then slowly-developed paralysis, of the
forearm and hand. Some paresis of left leg. Double optic neuritis.
Violent headache.
This patient was in charge of Hughes-Bennett at the Hospital for
Epilepsy and Paralysis, London. He diagnosticated brain tumor, and
suggested its removal. Rickman Godlee trephined over suspected region,
and removed a glioma of the size of a walnut. The operation was
performed November 25th. The patient did well until December 16th,
when he was seized with a rigor, followed by fever, sickness, and pain
in the head. A hernia cerebri of large dimensions supervening, he died
December 23d.
Pathology and Location: Glioma.
Meningitis was found at the lower border of the wound, spreading
downward toward the base of the brain.
Remarks: Hughes-Bennett and Rickman Godlee, _British Medical Journal_,
Nov. 29, 1885.
25. Sex and Age: F. —.
Clinical History: Syphilitic history. Tingling sensation and numbness
of the left arm and leg, which increased until it ended within six
weeks from its commencement in complete motor paralysis, with a
deficiency in the perception of touch. Left side of the face also
slightly paretic. Mental confusion and loss of memory.
Pathology and Location: After antisyphilitic treatment and
counter-irritation, trephining was performed over the middle of the
ascending parietal and frontal convolutions. Internal table of the
disc removed was found softened and thicker than usual, having on its
internal surface projections or roughnesses. A second opening was made
over the occipital region, and a similar thickening was found.
Opposite first opening the dura mater pale and thickened. It was
elevated, and a false membrane of yellow color was removed. An
incision was made in the direction of the {1075} paracentral lobule,
when a gush of grumous, red-colored fluid escaped.
Day after the operation much better; on third day moved her toes;
within a week lifted her leg; fingers moved within a week. Mind
greatly changed for the better.
Remarks: Macewen, “Proceedings of Path. and Clin. Soc. of Glasgow,”
_Glasgow Med. Journ._, vol. xxi., 1884, p. 142.
_Centrum Ovale—Fronto-parietal Region._
26. Sex and Age: F. 16.
Clinical History: Fell when sixteen months old from the table on her
head. Left hand, five months later, noticed at times to be stiff and
firmly closed. Three months later the leg became similarly affected,
and two months later general paroxysms. Many seizures for periods of
weeks or months, then intervals of freedom. Spasm began by contraction
of the left hand: she would lie down and jerk for a half minute or
minute, laughing or talking all through it, never losing
consciousness. In about six years left leg became paretic. Seizures
became much worse and more frequent; unconscious for six weeks, and
fifty to eighty spasms in twenty-four hours. Ten months without spasms
until a week before death, when they returned with great violence.
Spasms always began in the left hand; appeared to extend to the leg
first, and then to the face. Intellect clear.
Pathology and Location: Fibro-glioma.
In the white matter, but touching upon the gray at several spots at
the position of the upper end of the ascending frontal convolution of
the right hemisphere. The tumor occupied largely the anterior portion
of the paracentral lobule.
Remarks: Osler, _Medical News_, vol. xliii., Jan. 19, 1884, in
“Proceedings of Medico-Chirurgical Society of Montreal;” also, _Am.
Journ. Med. Sci._, N. S. vol. lxxxix., Jan., 1883, p. 31.
27. Sex and Age: M. —.
Clinical History: Severe fall, followed by insensibility. Paralysis of
the left side followed injury, but improved. Three years later,
epileptic convulsions: sudden fall, general spasm, biting tongue.
These attacks replaced by partial or localized epilepsy without loss
of consciousness: tonico-clonic spasm of muscles of left side of face
and neck and of left upper extremity, especially of the thumb and
index finger. Left pupil a trifle larger than right; left cheek
paretic, left arm and forearm absolutely paralyzed; left leg weak.
Marked tactile anæsthesia on left side. Ophthalmoscope showed fulness
of veins, but no neuro-retinitis. Late, some opisthotonos. Deafness in
right ear; axillary temperature, 36.4° C. Pain in right arm and leg
and in posterior part of head on right side. Conjugate deviation of
head and eyes from palsied side. No neuro-retinitis. Localized and
general convulsions recurred from time to time.
Pathology and Location: Sarcoma.
Larger than a hen's egg in white substance of right hemisphere,
occupying the whole thickness of the hemisphere above the opto-striate
bodies. Exerted much pressure upon these bodies, on convolutions near,
and even upon the inner surface of the left hemisphere. Adherent to
the dura mater. Right half of the brain much enlarged, and lateral
ventricle and septum lucidum forced over to the left. Two depressions
on the top of the skull; dura mater depressed and adherent to
convolutions. Some pachymeningitis.
Remarks: E. C. Seguin, _Opera Minora_, p. 215; reprinted from the
_Transactions of the Amer. Neurol. Ass._, vol. ii., 1877.
28. Sex and Age: M. 34.
Clinical History: Attacks of right-sided epilepsy every four or six
weeks; later, every week or oftener. Spasms wholly restricted to the
right arm or leg; the slightest attacks only momentary shocks on the
right side of the body. No spasm in the face. Only very rarely lost
consciousness. Never frothed at the mouth, bit his tongue, or
micturated in the attacks. In intervals had good use of his right hand
and leg up to a late period. Paresis of right limbs came on with
indefinite numbness of right leg. Diffused headache, mostly frontal.
No facial palsy; no anæsthesia. Knee-jerk absent on left side and
strong on right. {1076} Later, complete paralysis of right arm and
leg, with œdema. Violent headaches, more to the left of the median
line at the vertex; photophobia, nausea, and vomiting. No
neuro-retinitis. Still later, paresis, and then paralysis of right
face. Atrophy; contractures; bed-sores; semi-coma; profuse sweating;
high temperature; conjugate deviation of the eyes to the right; head
straight.
Pathology and Location: Sarcoma.
In centrum ovale, underneath the left cortical motor area, and
completely undermining it, was a large cavity which contained a large
amount of coffee-red serum, and also a tumor lying on its inner side
near the paracentral lobule. The tumor was connected behind with the
falx cerebri in the region of the paracentral lobule.
Remarks: E. C. Seguin, _Opera Minora_, p. 499, and _Journ. of Nerv.
and Mental Dis._, July, 1881.
29. Sex and Age: M. 22.
Clinical History: First symptom was a fit, which was followed by a
rigor. After this fit paresis of right arm and leg, with inability to
articulate properly. Could not raise the affected arm, but could grip
objects weakly. Paralysis of right side of face and tongue. Was quite
rational. No loss of sensation. Later, violent headache, followed by
vomiting. Slight amelioration of many symptoms, soon followed by
second attack of violent headache, which could not be localized;
complete right hemiplegia and aphasia. Later, dysphagia. Death rather
sudden.
Patient had had amputation of thigh about six months before for
sarcomatous enchondroma of head of the tibia. Had also had chancre
four years before.
Pathology and Location: Enchondroma.
In left hemisphere, between anterior part of corpus striatum and
“surface of frontal lobe.” The cortex over tumor and the outer and
anterior portion of corpus striatum were softened and broken down.
Remarks: T. P. Pick, _St. George Hosp. Rep._, vol. ix. p. 663.
30. Sex and Age: F. 16.
Clinical History: Patient was a wayward, hysterical girl of neurotic
family, precocious, and with abnormal sexual instincts and
indulgences. Had a sudden attack of total blindness, then sudden
recovery; sudden blindness again, and deafness; then restoration of
hearing; loss of power in lower limbs, ending with total blindness,
deafness, and paraplegia. Had dilated pupils and some hyperæsthesia;
also marked hysteroidal attacks, becoming at last maniacal.
Negatively, no constant headache or affection of ocular, facial, or
lingual muscles, no convulsions or vomiting; no abnormal
ophthalmoscopic appearances (except slight choked disc).
The case had been diagnosticated by many doctors and one of the “first
authorities in Europe” to be hysteria.
Pathology and Location: Tumor in right hemisphere, size of hen's egg,
translucent, and nodulated, soft, highly vascular, with small
extravasations of blood on its surface, occupied medullary substance
of middle lobe superior to lateral ventricle causing bulging of roof
of ventricle.
Remarks: A. Hughes-Bennett, _Brain_, 1878, vol. i. p. 114.
_Postero-parietal Region._
31. Sex and Age: M. 25.
Clinical History: Kicked on the head. Headache, nearly continuous,
with violent paroxysms. Vomiting at intervals, most when headache was
most violent. Vertigo. Mental confusion; sometimes maniacal. Left
convergent strabismus. Partial right hemianæsthesia. Patellar reflexes
slightly exaggerated; slight ankle-clonus on the right side. Blind in
both eyes; sight of right eye lost first. Choked discs, and eventually
optic atrophy. Hearing defective in right ear. Constipation.
Head-temperatures taken once; right parietal region, 98° F.; left
parietal, 97.8° F.
Pathology and Location: Fibroma.
Adherent to membranes, and involving the left postero-parietal and
occipital region to within half an inch of longitudinal fissure. The
brain-tissue around softened and broken down, the parts disintegrated
being chiefly the white matter of the postero-parietal and occipital
lobes.
Remarks: C. K. Mills, _Arch. Med._, vol. viii. No. 1, August, 1882.
32. Sex and Age: M. 49.
Clinical History: Dropping of left hand at intervals, with power
regained in about an hour. Brief attacks of loss of speech, and
numbness in lips and tongue on both sides. Numbness in tips of his
fingers and the left hand. Slight paroxysms of general rigidity.
Severe frontal headache. No vomiting. Loss of sight, gradually
increasing to total blindness. Involuntary micturition. Increasing
hebetude. Slow but probably correct intellection. Left upper
extremity, toward last, paretic. Was able to stand, but could scarcely
walk. Hearing and taste preserved. {1077} Some doubt as to smell.
Later, imbecile. After a severe fit of general convulsions he died.
Duration, about four months.
Pathology and Location: Carcinoma.
It occupied nearly exactly the site of the right “poster-parietal
lobule” (superior parietal). It was clear of the ascending parietal
convolution in front, and behind did not quite touch the external
parieto-occipital fissure; below it extended just short of the
intraparietal fissure, and on inner face of hemisphere reached for
half an inch into quadrilateral lobe. Below tumor toward ventricle
brain-substance softened.
Remarks: James Russell, _Brit. Med. Journ._, 1876, ii. p. 709.
33. Sex and Age: F. 36.
Clinical History: Right-sided temporal and orbital neuralgia.
Anæsthesia of left arm. Epileptic attacks. Slighter attacks of spasm,
without unconsciousness, in left face, left arm, and hand. Paresis of
left arm. Blindness. Optic neuritis. Pupils dilated and immobile.
Later, loss of smell and taste. Mental depression.
Pathology and Location: Gummata.
In right supramarginal lobule two tumors size of pea, lying
superficially.
Remarks: Broadbent, _Lancet_, Jan., Feb., 1874, quoted by Bernhardt,
p. 68.
_Beitrage zur Symptomatologie und Diagnostik der Herngeschwülste_, von
Dr. M. Bernhardt, Berlin, 1881.
34. Sex and Age: ——
Clinical History: Left hemiplegia with some anæsthesia. Deafness
developed in the left ear, with a total inability to localize the
origin of sounds.
Pathology and Location: Tumor size of an apple in middle of ascending
parietal convolution and backward. Around the tumor white softening,
which extended forward as far as the fissure of Rolando, and backward
throughout the right parietal lobe, and beneath almost into the
central ganglia.
Remarks: Strümpell, _Neurolog. Centralb._, Aug. 15, 1882.
35. Sex and Age: M. 54.
Clinical History: Middle finger of the right hand began to jerk
violently, also some of the flexor tendons. Twenty minutes after this
he had a fit, in which he became unconscious and beat himself
violently on the chest with the right arm. Had three of these fits.
Aphasic after this for two weeks. Had high fever at the time of the
seizures; was rubbed all over the body with ice. The fingers became
paretic, not the forearm or arm. Arm became numb at times, especially
after exertion. With dynamometer, left hand, 75; right hand, 55.
Headache, which ceased after some months. Right optic disc abnormally
red, but not choked; left disc normal. Had a convulsive attack in the
Philadelphia Hospital, in which the four fingers of the right hand
rapidly vibrated, contracting and extending without pain; no loss of
consciousness or other disturbance. The tongue was also affected, so
that speech was impossible. Later, the patient had a general
convulsion, preceded by a drawing sensation in the face; convulsive
movements began in right hand. Tongue bitten. Attack preceded by
severe headache. Had another attack without loss of consciousness or
convulsion, preceded by a sensation as of a knife cutting through the
flesh, which travelled up from the left hand to the shoulder, and then
to the head. Increasing loss of sensation in the fingers of the right
hand. Increasing difficulty of speech, with spells of melancholia and
crying. Right side of face markedly paralyzed. Right arm almost
entirely paralyzed and much swollen. Speech much affected; difficulty
in swallowing. Paralysis involves the right leg.
Pathology and Location: Gliomata.
A small tumor occupies the lower end of the left supramarginal
convolution, just where it joins the foot of the ascending parietal
convolution. The latter convolution was not involved in the tumor, but
was distinctly pressed upon in its lower third. The ascending frontal
convolution was entirely healthy.
In right hemisphere a similar gliomatous growth in the foot of the
angular convolution where it runs into the middle temporo-sphenoidal
convolution, involving also the upper part of this convolution, and to
a slight extent the deepest portions of the superior
temporo-sphenoidal convolution.
Remarks: H. C. Wood. Not before published.
{1078} _Occipital Region._
Occipital lobe—cortex and centrum ovale.
36. Sex and Age: M. 57.
Clinical History: Headache. Vertigo. Paresis of left side. Left facial
paralysis, especially middle branch. Vomiting. Right pupil dilated.
Tongue not involved. Uvula directed to left. Left velum palati
relaxed. Taste, smell, sight, and hearing normal; sensibility of whole
body normal. Reaction of degeneration on left side of face. Left side
of body shows reaction of convulsibility. Slight quantity of albumen.
Paresis declined with exception of facial nerve. Apathetic. Œdema of
lung.
Pathology and Location: Glioma.
In middle of right occipital lobe; lobe softened. Right lateral
ventricle narrowed and left dilated. Right posterior horn and right
thalamus opticus compressed.
Remarks: Petrina, _op. cit._
37. Sex and Age: M. 27.
Clinical History: Dysphagia, most marked with liquids, caused by
paresis of pharynx, more marked on left. Left hemiparesis for three
years. Headache (frontal and temporal), which is of a boring, tearing
character. Failure of memory. Speech guttural and monotonous. Puriform
expectoration. Later, feeble voice, hiccough, yawning, somnolence.
Pathology and Location: Fibroma.
On posterior face of left petrous bone and inferior occipital fossa,
extending behind occipital foramen and to right of cerebellar falx. A
prolongation involving the pneumogastric and glosso-pharyngeal, and
spinal accessory. Also cerebellar abscess.
Remarks: Cruveilhier, _Bull. de la Soc. Anat._, 1855, xxx. 475-479.
38. Sex and Age: F. 20.
Clinical History: Headache. Dimness in right eye, then in left;
finally, blindness in both. Convulsions. External strabismus; right
pupil dilated, left contracted. Coma, alternating with consciousness.
Vertigo. Optic discs congested, presenting small hemorrhages;
exophthalmus. Paresis of right arm and leg; partial anæsthesiæ on same
side. Earache. Vomiting, not frequent. Coma and death.
Duration, about three months.
Pathology and Location: Sarcoma?
Occupied all the posterior part of right hemisphere of cerebrum,
pressing upon and indenting opposite hemisphere and right half of the
cerebellum.
Remarks: S. O. Habershon, _Guy's Hosp. Rep._, 3d S., xx. 330-334.
39. Sex and Age: M. 18.
Clinical History: Periodical headaches. Pains in the neck and
vertebral column. Points of exit of trigeminal nerve sensitive.
Staggering gait. Diplopia. Confused sounds in right ear. Tetanoid
contractions of neck.
Pathology and Location: Echinococcus.
In right occipital lobe.
Remarks: Visconti, _Annal. Univer._, Oct., 1869, quoted by Bernhardt,
p. 98.
40. Sex and Age: F. 21.
Clinical History: Right hemianopsia. Central vision good. Other
symptoms: headache, dysarthria, anæsthesia of the right half of the
face. No paralysis, no mental symptoms. Choked discs.
Duration seven months.
Pathology and Location: Cystic glioma.