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.

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    Table IV. Supposed order of frequency of the different forms of epileptiform convulsions, the first fit appearing after the age of 45. 1. Intracranial tumours and other coarse cerebral lesions. 2. TJrsemia. 3. Thrombosis and embolism. 4. Alcohol, lead, &c. 5. Haemorrhagic apoplexy. 6. Idiopathic epilepsy. 7. General haemorrhage. 8. Itetiex irritation. 2. The character of the attack itself.—The most important points being:— (a) The mode of commencement, whether bilaterally or locally, the latter being very suggestive of a “ coarse ” cerebral lesion. ([b) The state of consciousness, whether lost at the com¬ mencement of the attack or not. In epileptiform convulsions due to a “ coarse ” cerebral lesion there is usually no loss of consciousness at the commencement; and, indeed, conscious¬ ness may be retained throughout the stage of bilateral spasms. In other bilateral epileptiform convulsions, consciousness is lost.* (c) The duration of the subsequent coma may give some information. In cases of cerebral haemorrhage, for example, the spasms (when they occur) are followed by prolonged and deep coma. In cases of uraemia and lead encephalopathy, the patient usually remains in a comatose or semi-comatose con¬ dition for a considerable time. In ordinary (genuine) epilepsy, consciousness is, as a rule, soon regained, though the patient may be stupid and confused after the attack. (d) The recurrence of the spasms.-—In uraemia, plumbism, and in some cases of cerebral tumour, there are repeated fits at short intervals. In some cases of genuine epilepsy, the same fact is observed. 3rd, and chiefly, The examination of the patient after the spasms have passed off.—In this examination, attention is to be directed to the following points:— (1.) The present condition of the patient. (a) The presence of any symptoms or physical signs indi- * This is the general rule ; exceptions occasionally, though rarely, occur. Thus, in some cases of convulsions due to cerebral softening, embolism, and thrombosis, there is no loss of consciousness. No. 3. 0 Yol. XY.
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