7. =Basal Vessels.= Anomalies in size and distribution, thickness
and character of vessel-walls (sclerosis, atheroma, aneurism,
calcification). Thrombosis, embolism, aneurism, sclerosis, atheroma,
calcification, obliterative endarteritis due to syphilis, are the
most common conditions. The changes in the middle cerebral arteries
are of especial importance in cases of apoplexy, softening, etc.
8. =Inner Meninges.= The arachnoid, subarachnoid space and pia are
usually considered together. The arachnoid bridges over the sulci,
the pia dipping down following the brain substance. The contents
of the subarachnoideal space are best seen, therefore, between the
convolutions. The inner meninges are gray, delicate and transparent;
the pial veins show plainly, the arteries are empty and lie deeper,
while the more superficial veins are uniformly filled with blood.
Sclerotic arteries run more superficially and are more prominent.
The removal of the skull-cap often gives rise to the presence of
air-bubbles in the pial vessels, and this should not be mistaken
for any pathologic condition. Hypostasis likewise should not be
regarded as a pathologic condition. Normally the membranes are
moist; in increased intracranial pressure (tumors, hydrocephalus,
hemorrhages) they are dry and dull. Inflammation is shown by a loss
of transparency of the membrane and by the presence of exudate in
the subarachnoideal space. Old thickenings are white and opaque. The
amount of fluid in the subarachnoideal space may be so great as to
cause the arachnoid to bulge out over the sulci. Note character of
exudate (purulent, fibrinous, serous or hemorrhagic). In purulent
meningitis greenish-yellow or yellowish-white collections of
thin pus are found in the meshes of the arachnoid; in fibrinous
inflammation the exudate is grayish or milky white. The normal fluid
(cerebrospinal) of the subarachnoideal space is clear and small in
amount. It is increased in œdema and congestion, as well as in serous
inflammations. In inflammatory conditions the membranes are dull and
cloudy and the fluid more or less turbid. Pathologic adhesions may
exist between dura and inner meninges, and between the latter and
the brain-substance. In the latter case the meninges do not strip
easily, but pull off portions of the cortex. Over tumors, gummata,
areas of softening, the meninges may be so adherent that they cannot
be separated from each other. In old syphilitics, alcoholics,
cachexias of old age, etc., the pia may be thickened, white and
opaque (leptomeningitis chronica fibrosa). Aneurisms of the pia
vessels are of great importance in cases of meningeal hemorrhage.
They may be very small (size of pea) and often are found only after
very careful search. Atheroma, infective emboli, etc., are also
causes of meningeal hemorrhage. Meningeal tubercles are very common
and often hard to recognize. They are usually best seen over the
basal meninges. Often they can be demonstrated by stripping off the
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