The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
_Localizing to the temporo-sphenoidal lobe._ The relation of sensory
aphasia to lesions of the temporo-sphenoidal lobe has already been
mentioned. The anterior poles of this portion of the brain, a region
frequently involved in head injuries, may lead to the development of
impaired smell and taste, especially if the lesion includes the uncinate
lobe and be situated on the left side. In other respects, the
temporo-sphenoidal lobe may be regarded as a ‘silent’ area of the brain.
_Localizing to the pre- and post-central convolutions._ Injury to the
pre-central or motor area usually leads to the development of definite
symptoms--twitchings, convulsions, or paralysis of the face and
extremities on the contra-lateral side. In the earlier stages reflexes
are abolished. Later on, as the result of degenerative changes in the
pyramidal tracts, spasticity, contractures, and rigidity, with increased
reflexes will be observed in the affected limbs. On the other hand, the
muscles do not show any reaction of degeneration. Babinski’s sign is
generally present.
Injury to the post-central convolutions might be expected to lead to
various alterations in tactile and muscle sense, in stereognosis, and in
sense of pain and temperature, but the general condition of the patient
seldom permits accurate demonstration. Such sensory disturbances are
more frequently observed as late results of head-injury.
_Localizing of the occipital lobes._ Laceration of the occipital lobes
may lead to homonymous hemianopia, for which defect it is probable that
the degree of laceration must be considerable, involving mainly the
mesial aspect of the occipital lobe (see Fig. 69). Schäfer has shown
that the greater portion of the occipital lobe may be removed in monkeys
without producing loss of vision, and it is only when the lesion
involves the parieto-occipital fissure and passes into the
occipito-temporal convolutions that loss of vision is permanent.
Slighter degrees of occipital injury may lead to subjective symptoms,
such as flashes of light, colour changes, &c.
_Localizing to the cerebellum._ Lesions of the cerebellum rarely permit
of the development of such localizing symptoms as are observed in
cerebellar tumours. Inco-ordination of movement, ataxia, and other
symptoms observed in cerebellar tumour formation are, from the general
condition of the patient, incapable of demonstration in cerebellar
laceration. It is necessary, however, to draw attention to the
significance of yawning and gaping. This symptom has been observed in
several recent cases, and, as far as my observation goes, is only
present in cerebellar lesions.
[Illustration: FIG. 58. THE CORTICAL MOTOR AND SENSORY AREAS.]
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