The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
The _cerebellar gait_ can of course only be demonstrated when the
patient is in a fit condition to walk. He shows, by the position of the
feet, a desire to obtain a wide base of support and staggers on, in his
desire to carry out his instructions, usually inclining towards the side
on which the lesion is situated. This inclination is probably dependent
on the weakness of the muscles of the ipso-lateral side (see below).
Another important feature may be observed in the tendency on the part of
the patient to turn the head in such a way that he faces somewhat in the
opposite direction, the chin being directed towards the opposite
shoulder.
_Disturbances of co-ordination_ may be demonstrated by telling the
patient to touch the tip of his nose with his finger, or to strike at an
object held a foot or two in front of him. Such attempts are
characterized by uncertainty and irregularity of movement, accompanied
by considerable tremor.
_Paresis or paralysis of the limbs on the ipso-lateral side._ The
abscess usually occupies the antero-external aspect of the lateral lobe
of the cerebellum, and is so situated that no direct pressure is
exercised on the pyramidal fibres. Some weakness--perhaps paralysis--of
the muscles of the extremities on the same side as the lesion can,
however, usually be demonstrated. According to Luciani, this is
explained in the following manner:--between the cortex of the one side
and the cerebellum of the other there are certain ‘associated’ fibres,
the strength of the impulses sent out from the cortex depending in part
on the integrity of these reinforcing cerebellar fibres. In cases of
cerebellar abscess these reinforcements are cut off with consequent
paresis, or even paralysis, of the muscles of the face, arm, and leg on
the same side as the lesion. Associated with this muscular weakness
there is usually some increase in the deep reflexes. Some of the
pyramidal fibres do not decussate, and, consequently, an ipso-lateral
paralysis may be associated with a contra-lateral paresis.
The same lessening of cortical impulses accounts for a weakening in the
external rectus of the same side, which muscle, acting with the internal
rectus of the sound side, allows of a conjugate deviation of the eyes
towards the opposite side, with well-marked _nystagmus_--of a coarse
type--on attempting to correct this deviation.
[Illustration: FIG. 78. A DIAGRAMMATIC ILLUSTRATION (AFTER LUCIANI) TO
EXPLAIN THE SYMPTOMS OBSERVED IN CEREBELLAR ABSCESS FORMATION. P.,
Pyramidal fibres; C.A., Right cerebellar abscess; R., Reinforcing fibres
from right cerebellum to left cortex; B.g., Basal ganglia; E.R.,
External rectus; N., Nucleus for sixth nerve; D.P.T., Direct pyramidal
tract; C.P.T., Crossed pyramidal tract.]
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