Clinical lectures on intra-cranial tumours. Lecture 2 / by Byrom Bramwell.

  • Byrom Bramwell
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on intra-cranial tumours. Lecture 2 / by Byrom Bramwell. Source: Wellcome Collection.

    5/16 (page 827)
    1881.] facial nerve has passed out at a point above the level of the lesion.1 ... 7 7 ,7 2. The Manner in which Motor Nerve Tissue is injured, whether irritated, or destroyed, or both irritated and destroyed.- It m«/y be laid down as a general proposition that all nerve lesions pioduce one or other of two results, viz., either diminished or increased function (it would perhaps be better to say perverted function, toi the increased function which results from pathological causes is never quite normal). We will, in the first place, considei tne derangements which are manifested externally as increased (per verted) function. _ Spasms (Convulsions).—The increased and perverted function which results from irritation (or loss of control) of motor nerve tissue by the pressure of a tumour is manifested externally as spasms and convulsions, and the lesion in such a case is said to be a u discharging ” one. But in making use of this term I must beg of you to remember that it is not the tumour itself which dischaiges, but the motor nerve tissue which is irritated by it. , The character of the convulsions, whether clonic.or tonic, de¬ pends in part at least upon the nature of the nerve tissue which is irritated, whether gray matter or conducting fibies. . Clonic spasms (epileptiform convulsions) might. theoretically be produced by irritation of any motor gray matter m the cerebrum, pons, or medulla. As a matter of fact, I believe they (clonic spasms) are generally due to discharge of motor centies in tie cerebral cortex. . . The extent and distribution of the spasms varies with the extent (and amount) of gray matter which is discharged. All degrees of clonic spasms (epileptiform convulsions), from the twitching of a single muscle or portion of a muscle to general (bilateral) epilepti¬ form convulsions, are met with. Limited epileptiform convulsions are very characteristic of a u coarse ” cortical lesion ; and it is mi portant to remember that, in such cases, the irritation has a great tendency to extend to and to involve adjacent and more distant centres, until, in some cases, the convulsions become general, and affect the muscles on both sides of the body. The following case is a striking example of this fact Case IV._Mary C., set, 37, a hawker, was admitted to this Infirmary, under my care, on 23d May 1875, suffering from right¬ sided convulsions and right-sided hemiplegia. Some years previously she had received a violent blow from a 1 The exact effects which a tumour causes in each of these situations will be diftcrivdiiils described. 2 An intra-cranial tumour can theoretically induce discharge o f a motor centre in other ways than by direct irritation (pressure), viz., by (1) causing arrest or interference with the blood supply of that centre by (a) direct pressuie on its nutrient vessels, (b) irritation of the vaso-motor nerves distributed to its nutrient vessels ; or (2) by reflex irritation of the convulsive centre m the medulla.