The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
(_C_) =To the post-central, angular, and marginal convolutions.= Attacks
of focal _epilepsy_ are frequently observed when the tumour occupies the
post-central convolution, such developments being probably dependent on
forward pressure effects. These epileptiform attacks, however, are
almost invariably preceded by some _sensory auræ_. Furthermore, the fits
will usually be followed by ‘some degree of anæsthesia or analgesia, a
loss of tactile sensation over half the body, affecting mostly the hand
and foot, with loss of power and astereognosis (inability to recognize
the form and consistency, and to name objects placed in the affected
hand)’ (Beevor).
When situated in the left angular gyrus, _word-blindness_ may
result--inability to appreciate the meaning of written words, &c.
When the tumour presses on the optic radiation, _hemianopia_ results,
with ipsolateral temporal and contralateral nasal blindness.
(_D_) =To the temporo-sphenoidal lobe.= When the tumour occupies the
anterior part of the temporo-sphenoidal lobe, more especially when it is
situated on the internal aspect of that lobe, the degree of _optic
neuritis_ is intense. Perversion or loss of _smell_ may be noticed--a
symptom of difficult determination on account of the general condition
of the patient.
As the result of pressure exercised on the optic tracts
_hemianopia_--with hemianopic pupillary reaction (the pupil not reacting
to light)--may be observed. Pupillary reactions, however, are
complicated by possible paralysis of the third nerve.
Some _weakness of the face muscles_ on the contralateral side is a
fairly constant symptom, presumably dependent on the upward pressure
exercised on the lower motor areas.
A tumour involving the more posterior and central portions of the lobe
may bring about a certain degree of _word-deafness_, whilst objects may
be incorrectly named or named with difficulty, the patient being more or
less aware of his mistakes and evidencing considerable annoyance of the
same.
In whatever part of the lobe the tumour be situated, certain sensory
auræ may be present. Not infrequently the patient falls into the
so-called ‘dream-state’. When sensory auræ are associated with crude
sensations of smell and taste, with chewing or spitting movements, the
tumour is probably situated on the antero-internal aspect of the lobe.
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