On optic neuritis in intracranial disease / by J. Hughlings Jackson.

  • Jackson, J. Hughlings (John Hughlings), 1835-1911.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: On optic neuritis in intracranial disease / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    (a.) Unilaterally beginning convulsion—in the hand, in the side of face or tongue, or both, or in the foot—followed or not followed, by temporary hemiplegia, points to disease involving some part of the cortex cerebri, usually in the mid-region of the brain. (b.) Slowly coming on hemiplegia of the ordinary form points to the cerebrum, and is strong additional evidence of tumour. Question.—Are not optic neuritis and headache often absent in this variety of hemiplegia, or late in coming on ? (c.) If, in a child with slowly coming-on hemiplegia, there be great enlargement of the head, there is a voluminous adventitious product of one cerebral hemisphere. (d.) Sudden hemiplegia may betoken haemorrhage from a cerebral tumour, which htemorrhage, if it be plentiful, may produce apoplexy too. Unless there be optic neuritis, or a clear history of intense headache, these cases cannot, in persons past middle age, be distinguished from cases of ordinary cerebral hsBmorrhage. Even when there is optic neuritis, there will then beBright's disease to be considered —the difficulty stated in Section I. In the two cases of uni- ocular neuritis already mentioned, the neuritis was the only thing I relied on for the diagnosis of tumour as a cause of the hemiplegia in each. (e.) Eeeling gait points to tumour of the cerebellum, or to tumour under the tentorium. If in children there be great increase of size of the head, the tumour is probably of the middle lobe. In these cases there may be tetanus-like attacks, and later there may be, also, continuous universal rigidity, mostly with retraction of the head. (/.) Affections of Cranial Nerves.—In my practice, only that of a physician, I rarely see double optic neuritis com- plicated with paralyses of the cranial nerves. When cranial nerves are paralysed, we have to distinguish into (1) Cases where certain of them are paralysed along with hemiplegia, and then whether the grouping points to tumour of the pons Varolii, or of the crus cerebri, or to tumour pressing on the crus cerebelli. The symptoms may be so grouped as to point to one lesion, and if they come on slowly together the diagnosis of tumour is, without other evidence, almost cer- tain. When they cannot be so grouped— as, for example, when paralysis of the parts supplied by one third nerve is on the same side as paralysis of the arm and leg—there are two lesions, and the diagnosis of intracranial syphilis is