Licence: In copyright
Credit: Arterial hypertonus, sclerosis and blood-pressure. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
218/234 (page 184)
![When, along with systemic hypertonic contraction, there is paralysis, it can be acconntecl for by the vessels in the particular area of brain affected having undergone greater structural alterations than elsewhei’e. This, however, leads now to the consideration of the cases of temporary and per- manent paralysis in persons whose arteries are thickened. Temporary and Permanent Paralysis in Persons with Sclerosed Vessels. In Cases 6 8 and 771 have shown how unreasonable, and even absurd, it would l^to regard the reciirring paretic phenomena as due either to liremorrhage or to thrombosis. That multiple attacks of temporary paralysis could be caused by an equally numerous number of hasmorrhages is quite unthinkable, and this is also the position as regards thrombosis. The only explanation possible is to regard the paretic attacks as due to recurring partial arrest of the blood supply to the motor strand, amlTlre only conceivable way in which this could be vessel constriction. The systemic vessels showed this constriction, while cerebral vessel constriction occurring coincidently would explain the paretic phenomena. In Case 78 the rapid recovery from the total paralysis seems to me to exclude the idea of either hremorrhage or thrombosis having occurred in the already damaged motor strand in the brain. Either of these in such a damaged area would have iuevitably_led to^a jrermanexqt loss of j)oweiy_aud yet no such loss resulted. I know of no other way to account for the temporary lowering of the circulation in the damaged area than by assuming that vessel constriction had occurred. Looking further at Case 68, I again contend that it is most unreasonable to suppose that tlrere was even a small hiemorrhage into the brain. A small lunmorrhage into the motor strand would destroy some fibres permanently, a fact equally true of thrombosis, unless the collateral circulation were very promptly established, which in the brain cannot be assumed as likely. The pronounced motor jjaralysis with aphasia must have Ixeen due to a jiartial arrest in the blood sup])ly to the great motor strand ; the arrest cannot have been complete, for had it been, softening would have taken](https://iiif.wellcomecollection.org/image/b28036591_0218.jp2/full/800%2C/0/default.jpg)
