Compendium of regional diagnosis in affectations of the brain and spinal cord / Translated by F.S. Arnold.

  • Bing, Robert.
Date:
1913
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Licence: In copyright

Credit: Compendium of regional diagnosis in affectations of the brain and spinal cord / Translated by F.S. Arnold. 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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    come on, for this signal symptom is of determining weight in the diagnosis of the situation of the cortical lesion. If, for instance, the attack begins in the fingers of the right hand—the contractions may at first affect the thumb alone—the focus—most frequently a neoplasm, but also, possibly, a cicatrix, a foreign body, a small abscess, or a circumscribed meningitis—will be situated in the left posterior central convolution, at the point marked h in Fig. 59. If the spasm commences at the left angle of the mouth, the lesion is situated on the right side, at A lesion here irritates the neighbouring pyramid cells, and the irritation spreads gradually over the contiguous areas of the cortex, like waves produced on the surface of water by a stone. The muscles will be involved in an order corresponding to the relative positions of their cortical centres. In severe cases the Jacksonian spasms may pass over also to the opposite limbs, and may be accompanied by loss of consciousness. A very intense irritation may spread to the motor area of the opposite hemisphere by way of the commissural tracts, and, further, may deaden the higher psychic centres, especially those in the cortex of the frontal lobe. The bilaterally innervated muscles (frontal, palpebral, masticatory, sterno-mastoid, etc.) are, in these cases, affected simultaneously on both sides. Unless the diagnosis is supported by the presence of other symptoms—symptoms of cerebral pressure such as slowing of the pulse, obstinate headache, choked disc, cerebral vomiting, etc.—or unless a history of cranial trauma helps to confirm it, cortico-epileptic attacks do not enable one to infer with absolute certainty the presence of a lesion in the cortical motor areas. For, in the first place, there is a form of genuine epilepsy, which presents the typical Jack- sonian symptomatology, the so-called idiopathic hemi- epilepsy —it is true that more recent experiments and the results of surgical procedures have shown that, as a matter of fact, alterations in the region of the cortex underlie this form (cysts, encephalitis)—and, in the second, intoxications and auto-intoxications (alcoholism, absinthism, uroemia, etc.) may evoke Jacksonian attacks by chemical irritation of the motor cortex. All these conditions may also lead to tran- sitory monoplegic or hemiplegic pareses. Only where the