The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876
Date:
1836
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Licence: Public Domain Mark

Credit: The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan. Source: Wellcome Collection.

    25/1050 (page 3)
    ■v' shocks rapidly followed this, and during the three or four days following, the right arm continued torpid and somewhat weaker than that of the opposite side. At first there were intervals of months between these attacks ; they then became more frequent, re-appearing every ten or twelve days, uniformly limited to the right arm, and at the same time paralysis of this limb, at first transient, became permanent, and more and more complete. Insensibly also the right lower extre- mity lost the power of motion ; it never however exhibited any convulsive movement. Before entering the hospital he was attacked with giddiness, which becoming more severe, determined him on applying for admission. His state then was as follows :■— The face and eyes injected ; some difficulty in articulating his words ; answers slow, but correct ; recollection clear ; diplopia from time to time ; commencing deafness. The patient complains of a dull pain towards the back part of the head, on the right side as well as on the left. The two extremities of the right side cannot be moved at the will of the patient ; they exhibit however a certain rigidity, and yesterday again the arm suffered five or six shocks, which caused the patient to suffer considerably. Pulse very hard, but not frequent. The pulsation of the heart strong. The muscular system even still remarkably well developed. Just when I had drawn up these details, and we were going to bleed the patient, he was seized with all the symptoms of apoplexy, and died the following day. Post mortem.—In the place ordinarily occupied by the left part of the tentorium cerebelli, there was found a large tumour which compressed the posterior lobe of the cerebral hemisphere of this side, and also the cerebellum. The structure of the cerebral hemisphere not changed, the tumour being principally developed on the side of the cerebellum, the entire left lobe of which had undergone a most remarkable change, it being very much diminished in volume, and its substance having- acquired extraordinary hardness. Neither the cerebrum nor cerebellum were continuous with the tumour. Interposed between them, and evidently produced at the expense of the dura mater, whose place it occupied, this tumour very much resembled that described in the preceding case, except that it contained in some parts a little calcareous deposit. In the right hemisphere of the cerebrum was found an enormous sanguineous effusion, which, occupying the corpus striatum and optic thalam.us, had made its way into the two lateral ventricles through the lace- rated septum. The parietes of the heart were hypertrophied. Remarks.—In this, as in the preceding case, the cerebrum was not all affected ; but one of the lobes of the cerebellum, being compressed by it, underwent consi- derable atrophy. Still none of those functional disturbances, which, according to authors, are connected with lesions of the cerebellum, were here remarked. The symptoms were just the same as if the tumour were seated in the cerebrum. The development of the osteo-fibrous tumour of the dura mater, seemed to be owing originally to the fall which the patient had suffered several years previously. SECTION II. DISEASES OF THE ARACHNOID AND PIA MATER. There are few diseases whose symptoms present so many varieties and so many individual differences as acute inflammation of the meninges. Are there well marked signs, by the aid of which we may readily distinguish during life inflamma- tion of the meninges lining the upper surface of the brain from that connected with the lower surface of this organ? Are there any special functional disturbances apper- taining to inflammation of the membrane lining the parietes of the ventricles ? By what signs can we recognise inflammation of the membranes lining the spinal cord ? B 2