The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
A prize-fighter was knocked out by a blow on the right side of the
head, dying a few hours later. The post-mortem revealed no fracture of
vault or base, but a linear laceration of the brain on the mesial
aspect of the right hemisphere which exactly corresponded to the free
margin of the falx cerebri. In this case, therefore, conclusive
evidence was obtained that the brain had been driven from right to
left against a firm and resisting barrier, corresponding laceration
resulting.
The lacerated area is usually cone-shaped, the base corresponding to the
surface of the brain, the apex facing towards the lateral ventricles. In
the most severe cases the anterior or lateral horns of the lateral
ventricles may be involved at the apex of the cone, and, in the event of
further cerebral softening, the horns of the ventricles may, as it were,
bulge outwards, thus assisting in the formation of those traumatic
cephaloceles that communicate between the lateral ventricle and the
surface of the brain.
On the other hand, if the degree of laceration be slight and the injury
compatible with life, organization and partial resolution takes place,
with the formation, in nearly all cases, of adhesions between the cortex
and the membranes, of false membranes, arachnoid cysts, and of blood
cysts. In the more serious cases cerebral fibrosis results, in direct
proportion to the degree of cerebral destruction, with corresponding
degeneration, both of the cerebral cortex and of the tracts that evolve
therefrom.
=Symptoms.= Certain regions of the brain may, when injured, give rise to
localizing symptoms. More generally, however, all localizing features
are obscured by an overpowering element--the presence of concussion,
irritation, or compression of the brain.
Still, in some cases, the localizing features are sufficiently marked,
at some period of the case, to allow of a more definite diagnosis. The
symptoms, therefore, must be considered under the two heads, (A)
_localizing_, and (B) _general_.
A. Localizing symptoms.
_Localizing to the frontal lobes._ Phelps,[33] from a series of 130
cases, arrived at the following conclusions--that, ‘in nearly every case
in which consciousness was retained or regained, and the mental
faculties not perverted by general delirium, laceration of the left
frontal lobe was attended by default in intellectual control, and that
the lesion was usually of the anterior region and implicated its
inferior surface.’ ‘Subcortical disintegration was characterized by
abrogation of mental power, and superficial laceration by aberration in
its manifestations.’ And secondly, that, ‘in nearly every instance in
which laceration was confined to the right side, the mental faculties
remained unaffected, except as they were obscured by delirium and stupor
occasioned by coincident general lesion.’
Public-domain text, read in full here on John Shaqi.
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