Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare.

  • Hare, H. A. (Hobart Amory), 1862-1931.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare. Source: Wellcome Collection.

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    Simultaneous in occurrence, as it is possible for one lesion in one place to produce paralysis of the face and another elsewhere to pro- duce the hemiplegia (see Ptosis in chapters on Face and on the Eye). If in the development of symptoms of cerebral hemorrhage there be little hemiplegia and temporary unconsciousness, followed in some hours by a sudden aggravation of the symptoms, it may be that in the beginning of the attack the lesion has been in the frontal lobes, but has gradually extended backward until it has ruptured into the lateral ventricle. So, too, a hemorrhage into the occipital lobe or the posterior part of the parietal lobe is rarely marked by much hemiplegia, and, if present, the leg is more paralyzed than the arm. The characteristic symptom, however, is well-marked hemian- sesthesia (see chapter on Skin), and hemianopsia (see chapter on Eye). Generally, however, such changes result from a thrombosis. When there is developed, in cases of hemiplegia, aphasia or dis- ordered speech, there is probably a lesion in the neighborhood of the third frontal convolution, or the island of Reil (see chapter on Speech). Hemiplegia may be due to cerebellar hemorrhage, in which case there are loss of consciousness deepening into profound coma, con- tracted pupils, vomiting in many of the cases, and fiually death when hemorrhage breaks into the lateral ventrich. The diagnosis of cere- bellar hemorrhage is very difficult. Of the irregular forms of hemiplegia there are several. Some- times the leg is from the beginning more affected than the arm, and remains paralyzed long after the face and arm have recovered. The leg may become rigid and distorted by contractures, and there will often be found present marked anaesthesia of the skin of the paral- yzed leg and arm, with hemianopsia and aphasia. Such symptoms indicate a lesion of comparatively small size involving the leg-fibres and some of the sensory fibres in the internal capsule, and results from rupture of the lenticulo-optic artery. When the arm suffers most the symptoms just described as in the leg are seen in it, and motor aphasia, if the lesion is on the right side, is often very marked, as is also facial paralysis. This is supposed to be due to the anterior frontal artery, a branch of the anterior cerebral artery, beco m i n g d i seased. When post-hemiplegic chorea attacks the paralyzed limbs there is often a focal lesion in the posterior extremity of the internal capsule. The symptoms we have just detailed may also arise, as we have