Chronic progressive softening of the brain : report of cases, with autopsies simulating cerebral tumor / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Chronic progressive softening of the brain : report of cases, with autopsies simulating cerebral tumor / by J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    CHRONIC PROGRESSIVE SOFTENING OF THE BRAIN: REPORT OF CASES, WITH AUTOPSIES SIMULATING CEREBRAL TUMOR.1 By J. Ramsay Hunt, M.D., OF NEW YORK, CHIEF OF THE NEUROLOGICAL CLINIC AND INSTRUCTOR IN NERVOUS DISEASES IN THE CORNELL UNIVERSITY MEDICAL COLLEGE, NEUROLOGIST TO THE CITY HOSPITAL, ASSISTANT PHYSICIAN TO THE MONTEFIORE HOME. Wernicke, in his Lehrbuch der GehirnkranJcheiten, published in 1881, describes a form of chronic progressive softening of the brain not dependent upon and having no evident relation to vascular disease. This form he distinguishes sharply from the encephalo- malacia of embolic or thrombotic origin. The importance of this group of cases is emphasized because of the resemblance which they bear in their clinical course to that of abscess and tumor of the brain. The affection is rare, and while not a few of the older cases described under this head are relegated to the domain of tumor or abscess there still remain five cases— four the observations of Andral and one of Birch-Hirschfeld—which he regards as unassailable. Clinically the cases are characterized by the gradual development of hemiplegia accompanied by irritative sensory symptoms and more or less anaesthesia, but without apoplectiform manifestations or very severe general cerebral symptoms. The focal symptoms continue to progress slowly for months, a year, or even longer, then ceasing to progress and remaining stationary. It is during the progressive stage that the resemblance to tumor is most striking. Postmortem, areas of white and yellow softening were found in the centrum semiovale, invading the basal ganglia and rarely extending to the cortex. The vessels of the circle of Willis, while perhaps showing some arteriosclerotic changes, were patulous and free from occlusion, in the distribution corresponding to the broken- down and softened brain tissue. This type of brain softening occurring without apparent relation to vascular obstruction, was described by the older writers on