Report on cases of cerebellar disease treated in the Royal Infirmary during the last three years / by T. Grainger Stewart and G. A. Gibson.

Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Report on cases of cerebellar disease treated in the Royal Infirmary during the last three years / by T. Grainger Stewart and G. A. Gibson. 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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    moderately dilated. The patient was absolutely deaf in the left ear, and the right was impaired. Dr. M‘Bride reported that the left tympanic membrane was thickened and indrawn, and expressed the opinion that the impaired hearing was due to disease either within the cranium or labyrinth. Motor fuTictions.—The organic reflexes were unimpaired ; the skin reflexes were but slightly marked, with the exception of the plantar; the knee-jerks were exaggerated on both sides, and there was some ankle-clonus on both sides. Voluntary movements were feeble, both as regards grasping with the hands and pushing with the feet. The co-ordination of muscular movement was somewhat impaired. When walking along a plank the patient always lurched to the left side. When standing with the feet together and the eyes shut he always fell to the left side, as already mentioned. Vasomotor and trophic functions.—The vasomotor and nutritive functions were in no way impaired. Cerebral and mental functions.—The intelligence was good, and the attention could be sustained well. The memory, however, was impaired. Speech was unaffected. There was much insomnia. There was no pain on percussion of the cranium. Locomotory system.—The muscles of both thighs, as well as those around the left side of the mouth, exhibited fibrillary twitchings. The symptoms in this case seemed to point to a lesion of the cerebellum, probably situated on the left side. Professor Chiene was therefore called in consultation, with a view to operation. On the 15th March he operated by making a curved incision with its vertex backwards from behind the mastoid process, on the left side of the occipital protuberance. The flap was turned down; an opening was made in the skull, midway between the occipital protuberance and the tip of the mastoid process. The dura mater did not bulge to any considerable extent. The opening was enlarged to the size of a shilling- piece, and then the cerebellum bulged considerably, while a large quantity of serous fluid flowed out. By pressing on the cerebellum, Mr. Chiene sought to favour the escape of the