The differential diagnosis of a case of epileptiform convulsions / by Byrom Bramwell.

  • Byrom Bramwell
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: The differential diagnosis of a case of epileptiform convulsions / by Byrom Bramwell. Source: Wellcome Collection.

    5/14 (page 183)
    Practical Step No. 1. Ascertain from the patient's friends, or from himself, as soon as he becomes sufficiently conscious, ivhether he has had previous attacks, and for hoiv long. Positive information on this point enables us at once to divide cases of epileptiform convulsions into two great groups. A. Cases in which there have been repeated attacks of a similar character, which have not been attended with any serious disturbance of the general health. In such cases, the cause of the convulsions is, in all prob¬ ability, the disease idiopathic or genuine epilepsy. Exceptions occasionally occur; in some cases of organic brain disease, especially syphilitic tumours pressing upon the motor area of the cortex, the grey matter gets into the habit of discharging, and may continue to discharge (% e., the patient may con¬ tinue to take fits) for a long time after the original source of irritation (the syphilitic gumma) is removed. In such cases there may be no symptoms of coarse lesion, when the patient comes under observation; and, unless the history of the case, as to previous headache, vomiting, &c.; the aofe at which the fits commenced; and the exact character of the spasms, be carefully inquired into, the case may be thought to be one of the idiopathic or so-called genuine disease.* B. Cases in which there is no history of a previous attack (either because this is the first fit, or because the patient cannot [from coma, stupidity, or other cause] give any infor¬ mation on the point) or in which the fits have only commenced of late. The convulsions may in such cases be due to any of the causes mentioned above. (See page 182.) In pursuing the inquiry the following circumstances must be taken into consideration :— 1. The age of the patient.—Some causes are undoubtedly more active at one period of life than at another. There are, however, so far as I am aware, no reliable statistics on the point. In the following tables I have attempted to give my own impressions as to the relative frequency of the different causes at different ages, presuming in all cases that the first attack * In some cases of plumbism the convulsions continue for some time after the other indications of lead poisoning (such as the blue line, colic, &c.), have disappeared ; but in all the cases of this description, which have come under my notice, there has been anaemia, and some affection of the general health. In some cases too of alcoholic epilepsy, the convulsions continue after the other indications of alcohol have disappeared.