The localisation of cerebral disease : being the Gulstonian lectures of the Royal College of Physicians for 1878 / by David Ferrier.

  • David Ferrier
Date:
1878
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Licence: Public Domain Mark

Credit: The localisation of cerebral disease : being the Gulstonian lectures of the Royal College of Physicians for 1878 / by David Ferrier. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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    to the leg, or invariably commencing in the leg, there are not many cases on record free from complication with paralysis, or in which the lesion remained circumscribed till death. I have already quoted two cases by Bourneville, in which crural monospasm complicated with paralysis was the chief symptom. A case is recorded by Broca' of crural monospasm caused by injury to the left side of the skull which was cured by trephin- ing ; but the exact position of the lesion I do not find recorded. MM. Charcot and Pitres ^ quote a case from Griesinger of spasm of the leg frequently recurring, and also invading the arm, followed in the interval by paralysis of the leg and arm. The lesion, however, was not strictly limited in this case. A hydatid cyst 4 centmietres x 4'3 centimetres was found on the surface of the opposite hemisphere, in such a position that its anterior border corresponded with a line drawn perpendicularly upwards from the external auditory meatus, i.e., about the upper extremity of the fissure of Eolando. There were also several small cysts on the frontal and parietal surface of tlie hemisphere. If the spasm can be ascribed exclusively to the large cyst, then its position agrees with the motor centres of the leg (fig. 27, [1] [2]). Hughlings Jackson^ has described a case in which fits began almost invariably in the right leg, and were frequently limited to it. The leg began to become weak, and more so after each fit, the paresis deepening ultimately into a permanent paralysis. In the last stages, signs of general affection of the left hemi- sphere—aphasia, &c.—manifested themselves. A tumour was found at the upper posterior part of the left frontal lobe, about two inches in diameter, bounded posteriorly by the fissure of Rolando, and extending forward into the posterior part of the first and second frontal convolutions. Another case is given by Hughlings Jackson'' of convulsions beginning in the left great toe, often confined exclusively to the left leg, and followed ultimately by paresis of the left foot. This patient also had paralysis of the right third nerve. After ' Soc. de Chirurgie, meeting of December 16, 1866. 2 Bevue MenmeUe, 1877, p. 369. ^ Medical Times and Gazette, September 4, 1875. * Ibid., September 18, 1876.