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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    circle of Willis. These vessels present some general thickening and a few disseminated plaques of arteriosclerosis. The internal carotid, however, and the adjacent portion of the middle central and posterior communicating at their origin show an extreme degree of arteriosclerosis, and on dissecting them out carefully the small perforating branches which pierce the anterior perforated space appear as the finest thread-like prolongations and are evidently atrophic. The Sylvian artery and its branches beyond this point are patulous throughout and free from sclerotic plaques. The hemisphere was then divided systematically by a series of transverse vertical cuts at right angles to its long axis. The abscess cavity was found to be pear-shaped, its base to the periphery, and extending downward and inward through the centrum semiovale. It is limited by a pyogenic membrane and the adjacent white matter is extremely oedematous and contains a few small hemorrhagic and purulent foci. Beneath the cortex of the face and arm centres the white matter is softened, gray and firm, containing a few small irregular cavities Very striking are the changes noted in the region of the basal ganglia. The caudate and lenticular nuclei, the optic thalamus and the internal capsule are the seat of small cavity formations, presenting sharp, irregular outlines and varying in size from a pin’s head to a grain of wheat, a few even larger. The nerve substance between these cavities is firm and normal in appearance, and the abscess cavity, with its oedematous and inflammatory areola, does not encroach upon this area. Histological Examinations. Bloodvessels. A series of sections of the sclerosed portions of the internal carotid, middle cerebral, and posterior communicating arteries wt re stained by the hsematoxylin- eosin method. All three of these vessels present an extreme arteriosclerosis of about one-half of the circumference of the vessel wall, with great proliferation of the intima. At the junction of the media and intima the endothelial prolifera- tion has undergone retrograde metamorphosis, and is broken down and degenerated; in some sections a moderate round-cell infiltration of the adventitia is also present A fibrin clot, containing a few leukocytes and red cells, is contained within the lumen of the vessels in the sclerosed areas and is adherent to the intima in a few of the sections; there are, however, no evidences of organization or old thrombus formations. The middle cerebral artery, distal to the sclerotic plaque, is entirely free from any thrombus formation. Many of the small arterial branches, taking their origin from the sclerosed portions of the internal carotid and middle cerebral arteries, present various stages of obliteration, old thrombus for- mation, and organization.