Intracerebral hemorrhage in the young / by B. Sachs.

  • Sachs, Bernard, 1858-1944.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Intracerebral hemorrhage in the young / by B. Sachs. 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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    case the jjreservation of consciousness, the lack of convulsions and the prompt recovery above all things, argue against the ])resence of polioencephalitis. The rarity of intracerebral hemorrhage in the young, in fact, in persons under forty, is acknowledged by all, and in the case which I wish to refer to now the diagnosis was considered un- certain by several neurologists, and yet this patient was nearly seventeen years older than my first case. Case II. I had the privilege of seeing in private prac- tice only a short time ago. The patient is a young man about nineteen years of age, with good family history, of excellent habits, and without hereditary or acquired syphilis. He is by no means frail in appearance, though rather undersized, and his father states that the boy stopped growing suddenly. About a year and one-half ago he waspreparing very earnestly for his college ex- aminations, when he was seized with a slight left hemiplegia. The onset was gradual, there were neither coma nor convulsions; and after three weeks, during which the symptoms had receded typi- cally, he had completely recovered. He went along very well for exactly one year when one day, as he was paying a visit, he felt numbness coming on as it did in the previous attack. He had courage enough to start for home; when he arrived there he began to vomit, became comatose (one and one-half hours after initial numbness) and remained in this state of coma for eighteen hours; no convulsions. He had complete left hemiplegia, but no aphasia although he was congenitally left-handed ; right-handed by edu- cation. The paralysis remained unchanged for a fortnight. Recovery began with leg ; now he has full use of his lower extremities, though he drags his left foot in characteristic fashion. He has exaggerated knee-jerks on both sides, and very marked double ankle clonus; his left hand is still paretic and contractured, no cardiac or renal trouble. The diagnosis reads intracerebral hem- orrhage, involving destruction of a large part of the internal cap- sule. In this case, mental overwork is considered the direct excit- ing cause; in the first case, no direct cause could be mad'e out. The child had no acute infectious or exhausting disease, and had not at that time the whooping cough—causes to which intracere- bral hemorrhage in the young has been ascribed by writers on the subject. I cite the second case to show the analogous symptoms in the two. In both hemorrhage occurred in persons far below the usual age limit; in both syphilitic changes can be safely ex- cluded. Convulsions were absent in both, while in the one case coma supervened during one of the two attacks. The second case proves the danger of this tendency to hemor- rhage when exhibited in very young persons—the danger of re- peated attacks. In this regard the prognosis must be held to be unfavorable. And now as to the pathology of the two cases. This is at once