On coma and the value of the ocular signs observed therein / by Burton Chance.

  • Chance, Burton Kollock, 1868-1965.
Date:
1907
Catalogue details

Licence: In copyright

Credit: On coma and the value of the ocular signs observed therein / by Burton Chance. 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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    Let us consider then the conditions under which coma may arise. The most complete coma is seen in gross disturb- ances of the cerebral circulation when it may come pn quickly without premonitory signs. Embolism and thrombosis of the cerebral vessels will produce symptoms similar to those occasioned by their rup- ture. In a typical apoplectic stroke the patient falls into deep unconsciousness from which he cannot be aroused. The face is injected, sometimes cyanotic, or of an ashen hue. The respiration is noisy and the pulse is slow. We must therefore ask ourselves the question when called to a case of suspected apoplexy whether the coma has been caused by an obstruction of the vessels or by their rupture. The age of the patient may guide us in determin- ing the probable cause and help us in our hope for his recovery. We may suspect arterial obstruction if the patient is young or is in early middle life, if there is fibrosis of the arteries, or if within a brief period several incomplete attacks have occurred be- fore the completely comatose condition has set in. The diagnosis at times may be cleared by a study of the ocular symptoms. In a typical seizure ptosis of the upper eyelid is a not very uncommon symp- tom, and the eyes may be fixed in the position of “conjugate deviation” which has been brought about as the result of the suspension, for the time, of all the functions of the affected hemisphere, so that no stimuli can be transmitted to the visual center— which may be paralyzed itself also. The pupils vary; usually they are dilated, and sometimes unequal. In deep coma they are always inactive. If there be a loss of reflex on one side and the pupil is rigid, doubtless the coma is due to a hemiplegic lesion. When a hemorrhage has flooded the ventricles, or is