Volume 1

A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel.

  • Rosenthal, Moriz, 1833-1889.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    JEtiology. Among the hypercemias peculiar to the cranial cavity must be men- tioned the conditions of congestion in chronic drunkards and opium eaters, and those which are due to paralysis of the vaso-motor centres from violent emotions and intellectual efforts. Extreme heat and cold, and insolation act upon the brain in the same manner. The tendency to cerebral congestion (often with vertigo), which sometimes accompanies lesions of the digestive organs, is also explicable by a vaso-motor irritation and increase of intra-cerebral pressure. This view is confirmed by the recent experiments of S. Mayer and Pribram (Sitz. der Wien. Acad., 1872), in which electrical or mechanical irritation of the walls of the stomach produced a reflex increase of the vascular pressure and considerable dim- inution in the frequency of the pulse. The causes of cerebral hyperfemia are more frequently found outside of the cranial cavity, and it is chiefly due to lesions of the circulatory and respiratory organs. The most active of these causes are organic diseases of the heart (valvular lesions) and disorders of the pulmonary circulation (emptiysema, chronic bronchitis, cirrhosis of the lung) which produce stasis in the right auricle and suj^erior vena cava, and consequently obstruct the return of blood from the brain. The afflux of blood to the brain may also be increased by marked cardiac hypertrophy. Increase of pressure in the vascular system is always accompanied, according to Jolly's experi- ments, by increase of the intra-cerebral pressure. This also occurs from stases of the inferior vena cava, in affections of the liver or other abdom- inal viscera, in dilatation of the hemorrhoidal veins, and in cessation of the menses. Obstacles to the return flow of blood also produce pas- sive hypernemia of the brain, as in compression of the jugular veins (tumors, enlarged glands, strangulation). The cerebral pressure in- creases when pressure is exercised simultaneously upon the carotids and jugulars. Changes in the arteries also furnish frequent causes of cerebral hyper- Eemia. When the afferent vessels are atheromatous (as in old age), or when their walls present, as in certain general diseases, an unusual fragil- ity or slight fatty degeneration (the hypoplasia described by Virchow in chlorosis), the pressure in the aortic system will be increased when the amount of blood increases, and will be followed by augmentation of the cerebral pressure from want of resistance in the vessels. We may then fmd a peculiar irritability of the nervous centres which causes them to re- act upon the slightest stimulant or upon very slight increase of vascular pressure. The laity, and even physicians, mistake this tendency to con- gestion, which exists even in feeble individuals, for true plethora. Symiytoms. As a general rule, cerebral hyperemia begins with symptoms of ex- citement, sometimes followed by depression. To the first category belong the headache with sensations of constriction, heat or heaviness, vivid red- ness of the face and conjunctiva (with rise of temperature in the exter- nal auditory canal), throbbing of the carotids, increased energy of cardiac action, fulness and force of the pulse. To these symptoms may be added, flashes of light, tinnitus aurium, vertigo, and uncertain gait. In more severe cases, nausea, vomiting, and hypenesthesia of sight and