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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    have not infrequently been observed in the monoplegic muscular area. Jacksonian attacks are very frequently ushered in by such paraesthesias (sensory aura); more rarely a lightning-like pain darts through the same area that is afterwards affected by convulsions. Broadly speaking, however, no very acute sensitiveness to pain is to be attri- buted to the cerebral cortex. The fearful headache from which so many patients with brain disease suffer, is not an irritative symptom to be referred to the cortex, but is rather to be ascribed to the extremely sensitive meninges. If the state of tension in the latter, due to increased intra- cranial pressure, be diminished by trephining or lumbar puncture, the pains also abate. Exacerbation of the pain on percussion of the skull over the central convolutions, etc., is, however, sometimes observed in tumours of the senso-motor area. (6) Motor and Sensory Disturbances of Subcortical Origin. A result of the fan-shaped or conical arrangement of the motor and sensory fibres in the corona radiata (rapid con- vergence of pyramid fibres and divergence of thalamo- cortical fibres), is, that the deeper the situation of a lesion between the cortex on one side, and the internal capsule and basal ganglia on the other, the more nerve tracts will be destroyed by it in proportion to its size. The crossed motor disturbances, therefore, due to lesions in the corona radiata, are, contrary to those produced by cortical and capsular lesions, of more than monoplegic, if not of definitely hemiplegic, type. As, however, lesions in the corona frequently interrupt the important commissural tracts of the corpus callosum, their symptom-complex sometimes includes the condition known as apraxia, which is characteristic of lesions of that body {vide infra, Chapter v.). As regards sensory disturbances, their intensity and extent is generally proportional to the depth below the cerebral cortex at which the lesion producing them is situated. Capsular paralyses may next be considered. Among