The scintillating scotoma or transient functional hemiopia : read before the Newark Medical and Surgical Society, Jan. 19, 1905 / by Charles J. Kipp.

  • Kipp, Charles John.
Date:
1905
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Credit: The scintillating scotoma or transient functional hemiopia : read before the Newark Medical and Surgical Society, Jan. 19, 1905 / by Charles J. Kipp. 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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    u state of the surface vessels and accessible arteries is an indication of the condition of those internal organs. Last, that the vasomotor spasm can cause a deliberate uniform and peculiar discharge is not only unproved, but is in the highest degree impossible. In short, the difficulties in accepting the vasomotor explanation of the sensory symptom is so great that it would only be admitted as a tenable hypothesis if there were no other explanation of the coincidence of the two phenomena. We know that the vascular system is in a special way un- der the influence of the cerebral centers. An emotional blush and the pallor of fear are conspicuous examples of this fact. It is at least as easy to believe that the vascular changes are the result of the disturbance in the nerve elements as it is to regard them as its cause. The vasomotor nerves are peculiarly sensitive to sensory impressions that are felt as pain. No symptoms at all resembling those of ihigraine have been observed when the sympathetic system is distinctively diseased or de- ranged. ^^The peculiar character of the visual impression af- fords strong reason for regarding it as the result of a tendency to functional derangement in the cells them- selves. This opinion is supported by the fact that it may occur as an isolated symptom, and that it may be related to an actual visual impression, as is shown by the facts mentioned. Such an occurrence can have been due only to a primary functional disturbance of the cells themselves, and that which exists in one case probably exists in all. ^^The hemiopia also is best explained by the assump- tion of deranged function in the occipital lobe, especial- lysince right hemiopia may correspond to almost simul- taneous aphasia, and the opinion is supported by the fact mentioned above that hemiopia is 'flxed by a lesion in the cuneiis. When all has been said, mystery still envelops the mechanism of migraine.^’ Jolly,® whose clinical experience with this affection is similar to mine, thinks: (1) That the seat of scintil- lating scotoma in its most frequent, hemiopic form in all probability is located in the primary optic channels and more particularly in the optic tract or in the region of the external geniculate body ; (2) that the binocular 9. Jolley: Berliner kiln. Woohft., No. 42, 1904, quoted from Nagel’s Jahresbericht, 1902, p. 459.