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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    The urine is negative and the other viscera present no abnor- malities. The optic nerves are normal. Percussion of the head over the left parietal bone was tender, but no difference in the percussion note could be made out. Note. August, 1902.—The patient was placed upon ascending doses of potassium iodide and for a short time the headaches improved but later returned with all their old severity in spite of vigorous antisyphilitic treatment. The weakness in the right hand and arm increased gradually and in September the right leg felt weaker, the right knee jerk became exaggerated, and pseudo-ankle clonus was elicitable, but no Babinsky. The temperature was normal and the pulse rate ranged between 72 and 90. The condition was evidently slowly progressing and the advisability of an ex- ploratory operation was considered by Drs. Vanhorne, Norrie, and myself. On October 22, 1902 the patient was examined by Dr. Dana, who concurred in the diagnosis of a progressive lesion beneath the centres for the face and hand and the advisability of surgical explora- tion. The case was transferred to the surgical ward for operation, in the service of Dr. Bern B. Gallaudet. Operation, October 29, 1902, by Dr. Gallaudet. An oval flap of bone was removed uncovering the left Rolandic area over the face and arm centres. The brain was rather less prominent than is usual and pulsated normally. The cortical convolutions were nor- mal in appearance. A needle was introduced four times into the suspected territory, in hope of puncturing a possible cyst, but with negative results. The dura was then sutured and the disk of bone replaced. On the following morning, October 30, 1902, the patient had a convulsive seizure limited to the right side, without loss of conscious- ness, and was found completely paralyzed on the right side. The wound was opened, the disk of bone removed and with it a a small blood clot on the outer surface of the dura. The bone was re- placed and the wound sutured. No more convulsive seizures occurred but the complete right hemiplegia persisted, with ankle clonus and the Babinsky reflex and loss of the skin reflexes on the right side. Patient was dull and apathetic and passed urine and feces incontinently. Pain impressions are felt at both sides but less keenly on the right. Because of the profound mental state of the patient and the completeness of the hemiplegia, it was thought probable that the exploration had been followed by hemorrhage. The man survived the operation one month, the right hemiplegia remained complete. The stupor, somnolence, incontinence of urine and feces continued. The temperature ranged from 100° F. to 101° F. and 102° F., but without marked remissions. No chills, no more convulsive