Lectures on nervous diseases from the standpoint of cerebral and spinal localization, and the later methods employed in the diagnosis and treatment of these affections / by Ambrose L. Ranney.

Date:: 1888

Credit: Lectures on nervous diseases from the standpoint of cerebral and spinal localization, and the later methods employed in the diagnosis and treatment of these affections / by Ambrose L. Ranney. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$LESIONS OF THE CEREBELLUM. The functional attributes of this ganglion are as _yet imperfectly determined, and the effects of lesions (tumors, hemorrhage, softeninii-, atrophy, and sclerosis) which involve its different regions vary with their seat. The following deductions are chiefly those of Nothnngel, who has devoted special attention to diseases of this ganglion. Seguin has also lately contributed to this field a valuable article. Lesions of one of the cerebellar hemispheres^ are often incapable of diagnosis, especially if only one hemisphere be involved. Lesions of the vermi form process are generally attended Avith symp- toms of a more decided character. Incoordination of movement, an intense verti'jo (identical with thnt of Meniere's disease), and a titubating gait,''^ are the more common effects of cerebellar lesions; but these are not in themselves pathogno- monic of cerebellar disease, because they may be produced by lesions of other parts of the brain. The consideration of all the morbid phe- nomena of each case (both of a positive and negative character) is required to render the diagnosis certain. A staggering gait is especially liable to be developed in case the worm of the cerebellum is directly involved, or is pressed upon by lesions of adjacent parts. It only exists when the subject is in the upright posture, and the ataxic symptoms rarely affects the delicate movements of the fingers. Gastric crises (chiefly exhibited by persistent vomiting) are a diag- nostic feature of lesions of the cerebellum, in many cases. When de- structive lesions of the cerebellum exist, vomiting is less frequently observed than when that ganglion is encroached upon by lesions of other parts. Atrophy of the cerebellum has been obser\ c(l to ])roduce imjjerfec- iions of speech (anarthria). The difficulty seems to be confined ex- clusively to the motor apparatus. The memory of words is not disturbed. It is probably to be attributed to interference with the speech tract (Fig. 24). Pain in the occipital region is often present in cerebellar disease. It may exist also in the frontal region, or be entirely wanting. The organ of vision may be affected. Occasionnlly, the eyes may exhibit incoordination of movement and nystagmus; and also the evi- dences of choked disc, amblyopia, and amaurosis. Hemorrhage into the cerebelluvi is sometimes associated with a loss of facial expression, due to a slight paresis. The patient umy also ex- hibit a tendency to assume one position, and to return to it when moved by the attendants. Should hemiplegia occur, in sucli a case, it indicates$