In a case recorded by Chipault and A. Chipault,[42] and characterised by
brief epileptiform attacks involving the left side of the face, cerebral
exploration proved ineffectual, but at the post-mortem a subcortical
glioma of the size of a cherry was discovered underneath the posterior
end of the second frontal convolution. Is a case of cerebral tumour to
be labelled _tic_?
It is quite exceptional, in fact, for lesions of the cortical facial
centres to give rise to muscular movements suggesting facial tic. Take
another instance:
An interesting case (says Brissaud), and one that is everywhere
quoted, is reported by Schultz, in which an aneurism of the
vertebral artery, at the point where the basilar arises, compressed
the trunk of the left facial nerve, and occasioned a "tic" of ten
years' duration. As a matter of fact, one could not have a better
example of _spasm_ pure and simple.
Féré[43] cites the following incident in support of the contention that
encephalic trauma may engender a tic:
A man in falling on his head sustained an injury to the cranial
vault over the posterior section of the left parietal bone, at a
spot exactly corresponding to the posterior part of the angular
gyrus, and immediately became afflicted with a convulsive tic of
the zygomatics and orbicularis palpebrarum on the right.
Conformably to Ferrier's experimental localisation of the motor
centre for the eye muscles and lids in the angular gyrus,
irritation of this centre by the cranial injury was the diagnosis
made.
The proffered interpretation of the motor phenomena by cortical
excitation is entirely justifiable, but no convulsion consecutive to
traumatism can ever pass muster as a tic.
A no less frequently quoted experiment of Gilbert, Cadiot, and
Roger,[44] supposed to confirm certain results obtained by Nothnagel, is
now a standard case in the history of tic hypotheses. The animal in
question was a dog affected with spasmodic twitches of the ear, which
the successive removal of cortical facial centre, internal capsule,
corpora striata, and cerebellum, signally failed to alleviate, and which
disappeared only with the destruction of the corresponding nucleus in
the pons. Their inability to find any anatomical change determined the
experimenters in favour of the view that the trouble was functional, and
they described it as a tic.
It would be foolhardy to deny the existence of a lesion on the ground
that it was not discovered. Negative findings of this sort are
valueless. The sole conclusion to draw from the incident is the
all-important rôle played by the bulbar centres in the production of
convulsive movements, which are in such circumstances, of course, nought
else than spasms.
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