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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    Summary of Case I.—(From Bellevue Hospital, I. Medical Division, service of Dr. Y. H. Norrie.) The gradual development of parsesthesise, objective sensory disturb- ances, and weakness, affecting the face, arm, and leg in succession, in a man aged fifty-three years. Severe paroxysmal headaches in the left parietal region and vertigo, no vomiting, no optic neuritis. Diagnosed as a progressive lesion, probably tumor, beneath the cortex of the face and arm centres and exploratory operation per- formed. Operation was negative and was followed by complete right hemiplegia, stupor and incontinence of the sphincters. Patient died one month later. Postmortem old areas of softening were found in the basal ganglia, internal capsule and the sub-cortex of the face and arm centres. In these sclerosed and degenerated areas obliterated vessels were present. The origin of the softening is to be referred to a localized arteriosclerosis at the junction of the internal carotid, middle cerebral, and posterior communicating arteries with progressive and successive obliteration of the small central perforating branches; the main arterial trunks were excluded by a recent thrombus. An abscess was situated beneath the leg centre invading the white matter, a sequela of the exploratory punctures. History. The patient, a mechanic, aged fifty-three years, was admitted to the Bellevue Hospital July 27,1902. He had been very moderate in the use of alcohol, and denied having had any venereal disease. He had enjoyed unusually robust health and had not been ill since childhood until one and one-half years before admission to the hospital, when he was suddenly seized with vertigo, and lost consciousness, while working at a turning-lathe. He remained in an unconscious state for nearly two hours, but was unable to say whether or not he had had a convulsive seizure. He remained in bed for two weeks suffering from weakness and vertigo on attempting to arise. At the end of that time he returned to his occupation, regaining his health and strength completely, which continued until six months ago, when he had another ver- tiginous seizure at the turning-lathe, but did not lose consciousness.. He was obliged to give up his occupation and remain at home,, owing to general weakness and vertiginous seizures. Two months later headaches made their appearance over the vertex and left parietal region. These would come on suddenly, were very severe, and would disappear as quickly as they came on. They would last from a few minutes to several hours, and at times were very intense. Between these paroxysms the head was comparatively free from pain. After three months of parietal and vertical headaches and ver- tiginous seizures parsesthesise made their appearance on the right cheek and about the angle of the mouth. They consisted of prickling.