Archives of Neurology & Psychiatry

PENFIELD, WILDER

doi: 10.1001/archneurpsyc.1936.02260090002001pmid: N/A

Abstract Introduction Preliminary case study Pattern of attack Neurologic signs Encephalography Electrical exploration Idiopathic (essential) epilepsy Pathologic physiology Results of sympathetic ganglionectomy Results of removal of carotid body and denervation of the carotid sinus Results of subtemporal decompression Results of spinal insufflation of oxygen Epileptiform seizures secondary to subdural exudation Epilepsy associated with injury at birth and with congenital abnormality of the brain Epileptiform seizures secondary to intracranial tumors Epileptiform seizures associated with meningocerebral cicatrix, cerebral cicatrix and cerebral atrophy Pathologic anatomy Results of craniotomies Radical excision Exploration without excision Ligation of cerebral arteries Evacuation of subdural fluid Summary and comment INTRODUCTION Surgical intervention should be employed in the treatment of epilepsy only when the operator has studied carefully the physiologic mechanism and the pathologic cause in the individual instance. The surgeon who performs a craniotomy without a carefully considered constructive hypothesis "places himself on a level with the References 1. Sargent, P.: Some Observations on Epilepsy , Brain 44:312, 1921.Crossref 2. Schürer-Waldheim ( Die chirurgische Behandlung der Epilepsie , Wien. med. Wchnschr. 84:1180 and 1239, 1934). 3. Hyperpnea (Foerster's method): The forced breathing is continued for ten minutes and should be energetic enough to produce temporary tetany. This precipitates an attack in less than SO per cent of the cases. 4. McQuarrie, I.: Epilepsy in Children , Am. J. Dis. Child. 38:451 [ (Sept.) ] 1929Crossref 5. Jackson, J. Hughlings: Selected Writings of John Hughlings Jackson , edited by James Taylor, London, Hodder & Stoughton, Ltd., 1931. 6. Holmes, G.: Local Epilepsy , Lancet 1:957 ( (May 7) ) 1927.Crossref 7. Foerster, O.: Die Pathogenese des epileptischen Krampfanfalles , Deutsche Ztschr. f. Nervenh. 94:15, 1926.Crossref 8. Brown, G., and Sherrington, C.: On the Instability of a Cortical Point , Proc. Roy. Soc., London, s.B 85:250, 1912.Crossref 9. Penfield, W., and Gage, L.: Cerebral Localization of Epileptic Manifestations , Arch. Neurol. & Psychiat. 30:709 ( (Oct.) ) 1933. 10. The explanation of this may possibly be the fact that epileptogenic discharge usually begins not in a lesion itself but in the gray matter adjacent to it. The more likely explanation, however, is that some sensory representation exists in the precentral gyrus as well as posterior to the central fissure. Local stimulation of the precentral gyrus frequently gives rise to a sensation of numbness and tingling in the part represented without movement. Furthermore, Dusser de Barenne obtained the same sensory effect by painting the precentral gyrus with strychnine as by painting the postcentral gyrus. 11. Gowers, W.: Epilepsy and Other Chronic Convulsive Diseases , London, J. & A. Churchill, Ltd., 1901. 12. Foerster, O., and Penfield, W.: Der Narbenzug am und im Gehirn bei traumatischer Epilepsie in seiner Bedeutung für das Zustandekommen der Anfälle, und für die therapeutische Bekämpfung derselben , Ztschr. f. d. ges. Neurol. u. Psychiat. 125:475, 1930. 13. Torkildsen, A., and Penfield, W.: Ventriculographic Interpretation , Arch. Neurol. & Psychiat. 30:1011 ( (Nov.) ) 1933. 14. Personal communication to the author. 15. Sargent 1 16. Etienne ( Le rôle des spasmes vasculaires, des troubles vago-sympathetiques et des troubles endocriniens dans la pathogénie de l'épilepsie , Rev. méd. d. l'est 61:249 [ (April 1) ] 1933) 17. Cobb and Finesinger ( Vagal Pathway of Vasodilator Impulses , Arch. Neurol. & Psychiat. 28:1243 [ (Dec.) ] 1932) 18. Penfield, W.: The Evidence for a Cerebral Vascular Mechanism in Epilepsy , Ann. Int. Med. 7:303, 1933. 19. Wilson, S. A. Kinnier: Modern Problems in Neurology , New York, William Wood & Company, 1929. 20. Stöhr, P., Jr.: Mikroskopische Anatomie vegetativen Nervensystems , in von Möllendorff, W.: Handbuch der mikroskopischen Anatomie des Menschen , Berlin, Julius Springer, 1928, vol. 4, p. 143. 21. Hassin, G. B.: The Nerve Supply of the Cerebral Blood Vessels , A. Research Nerv. & Ment. Dis., Proc. 9:437, 1930. 22. Penfield, W.: Intracerebral Vascular Nerves , Arch. Neurol. & Psychiat. 27:30 ( (Jan.) ) 1932. 23. Penfield ( A Technique for Demonstrating the Perivascular Nerves of the Pia Mater and Central Nervous System , Am. J. Path. 11:1007 [ (Nov.) ] 1935). 24. Chorobski, J., and Penfield, W.: Cerebral Vasodilator Nerves and Their Pathway from the Medulla Oblongata , Arch. Neurol. & Psychiat. 28:1257 ( (Dec.) ) 1932. 25. Stavraky, G. W.: Response of Cerebral Blood Vessels to Electric Stimulation of the Thalamus and Hypothalamic Regions , Arch. Neurol. & Psychiat. 35:1002 ( (May) ) 1936. 26. The procedure was carried out through four incisions in two stages, the anterior approach being used in each case. It is impossible to reach the vertebral artery or the ganglion usually found on it through the posterior incision of Adson. 27. Lauwers, M.: Le traitement chirurgical dans les épilepsies , Rev. neurol. 39:1377, 1932. 28. Weiss and Baker ( The Carotid Sinus in Health and Disease , Medicine 12:297, 1933). 29. Danielopolu, D.: Sur la pathogénie de l'épilepsie et sur son traitement chirurgical , Presse méd. 41:170, 1933. 30. Heymans, C., and Bouckaert, J.: Au sujet de l'influence des zones vasosensibles réflexogènes de l'aorte et des sinus carotidiens sur l'excitabilité corticale motrice , Presse méd. 41:729, 1933. 31. Gibbs, F. A.; Lennox, W., and Gibbs, E. L.: Cerebral Blood Flow Preceding and Accompanying Epileptic Seizures in Man , Arch. Neurol. & Psychiat. 32:257 ( (Aug.) ) 1934. 32. Lennox, W.: Personal communication 33. Weiss and Baker.26 34. Marinesco, G., and Kreindler, A.: Des réflexes du sinus carotidien en pathologie nerveuse , J. de physiol. et de path. gén. 29:77, 1931 35. Ask-Upmark.32 36. Ask-Upmark, E.: The Carotid Sinus and the Cerebral Circulation: Anatomical, Experimental, and Clinical Investigation, Including Some Observations on the Rete Mirabile Caroticum , Acta psychiat. et neurol. , (supp. 6) , 1935, p. 1. 37. Cobb, S.: Causes of Epilepsy , Arch. Neurol. & Psychiat. 27:1245 ( (May) ) 1932. 38. Elsberg, C., and Pike, F.: Studies on Epilepsy: Influence of General Increase or Diminution of Intracranial Pressure upon the Susceptibility of Animals to Convulsive Seizures , Am. J. Physiol. 76:593, 1926. 39. By negative results here is meant the finding of a normal-appearing brain or diffuse cortical atrophy. 40. Freidmann, R., and Scheinker, J.: Ueber therapeutische Erfahrungen mit der lumbalen Lufteinblasung bei epileptischen Anfällen , Deutsche Ztschr. f. Nervenh. 133:35, 1933. 41. Penfield, W.: Cranial Subdural Space , Anat. Rec. 28:173, 1924. 42. The diagnosis of Quincke's meningitis has been made in some of these cases. 43. Parker, H. L.: Epileptiform Convulsions: Incidence of Attacks in Cases of Intracranial Tumor , Arch. Neurol. & Psychiat. 23:1032 ( (May) ) 1930. 44. For a complete analysis of the epileptiform seizures associated with tumor in our clinic I have to thank Dr. I. Tarlov. Subtentorial and pituitary tumors are excluded. 45. Wagstaffe, W.: The Incidence of Traumatic Epilepsy After Gunshot Wound of the Head , Lancet 2:861 ( (Oct. 27) ) 1928. 46. Steinthal, K., and Nagel, H.: Die Leistungsfähigkeit im bürgerlichen Beruf nach Hirnschüssen mit besonderer Berücksichtigung der traumatischen Epilepsie , Beitr. z. klin. Chir. 137:361, 1926. 47. Schou, H.: Trauma Capitis and Epilepsy , Acta psychiat. et neurol. 8:75, 1933. 48. Penfield, W.: The Mechanism of Cicatricial Contraction in the Brain , Brain 50:499, 1927. 49. Penfield, W.: Meningo-Cerebral Adhesions , Surg., Gynec. & Obst. 29:803, 1924. 50. del Rio-Hortega, P., and Penfield, W.: Cerebral Cicatrix: The Reaction of Neuroglia and Microglia to Brain Wounds , Bull. Johns Hopkins Hosp. 41:278 ( (Nov.) ) 1927. 51. Penfield, W., and Buckley, R. C.: Punctures of the Brain: Factors Concerned in Gliosis and in Cicatricial Contraction , Arch. Neurol. & Psychiat. 20:1 ( (July) ) 1928. 52. Penfield, W.: Les effets des spasmes vasculaires dans l'épilepsie , Union méd. du Canada 63:1275, 1934. 53. The period during which these patients have been followed is short, and nothing less than a lifetime is altogether satisfactory. I began to operate on epileptogenic cicatrices, following the example of Otfried Foerster, in 1928, and my indebtedness to him is obvious. Five years before that date I had begun to study cerebral scarring with the possibility of such operations in view, and this analysis was furthered by Pio del Rio-Hortega, whose help I sought during the pathologic study.

McLEAN, A. J.

doi: 10.1001/archneurpsyc.1936.02260090038002pmid: N/A

Abstract Paraphysial cysts were first tentatively identified as such by Sjövall1 in 1909, but since that time the etiology in reported cases of these "colloid cysts of the third ventricle" has received either neglect2 or only irresolute attention. This might possibly be due to the fact that the cysts are comparatively rare (only forty-seven being reported in the literature of the past three quarters of a century, with but nine successful removals) or to the evident facility with which they may be confused pathologically with cystic degeneration of the choroid plexus when given only perfunctory consideration.3 Both preoperative diagnosis and curative therapeusis being now possible, the origin and adequate identification of these cysts should no longer remain shrouded in doubt. PHYLOGENIC CONSIDERATION The boundaries of the third ventricle, as the rostral portion of the primitive neural tube, have been the ancient proving ground for many phylogenic experiments and References 1. Sjövall, E.: Ueber eine Ependymcyste embryonalen Charakters (Paraphyse?) im dritten Hirnventrikel mit tödlichem Ausgang: Zugleich eine Beobachtung wahrer lipochromer Veränderungen mit Auftreten von "Halbmondkörperchen," Beitr. z. path. Anat. u. z. allg. Path. 47:248, 1909. 2. Masson, C. B.: Complete Removal of Two Tumors of the Third Ventricle with Recovery , Arch. Surg. 28:527 ( (March) ) 1934.Crossref 3. Drennan, A. M.: Impacted Cyst in Third Ventricle of Brain: Report of Two Cases , Brit. M. J. 2:47, 1929.Crossref 4. Fulton, J. F., and Bailey, P.: Contribution to the Study of Tumors in the Region of the Third Ventricle: Their Diagnosis and Relation to Pathological Sleep , J. Nerv. & Ment. Dis. 69:1, 145 and 261, 1929. 5. Zimmerman, H. M., and German, W. J.: Colloid Tumors of the Third Ventricle , Arch. Neurol. & Psychiat. 30:309 ( (Aug.) ) 1933. 6. McLean, A. J.: Pineal Teratomas, with Report of a Case of Operative Removal , Surg., Gynec. & Obst. 61:523, 1935. 7. Wilder, H. H.: The History of the Human Body , ed. 2, New York, Henry Holt & Company, 1923, p. 477. 8. Edinger, L.: Vorlesungen über den Bau der nervösen Zentralorgane des Menschen und der Tiere , ed. 7, Leipzig, F. C. W. Vogel, 1908, vol. 2, p. 203. 9. Selenka, E.: Das Stirnorgan der Wirbeltiere , Biol. Centralbl. 10:323, 1890-1891. 10. Eycleshymer, A. C., and Davis, B. M.: The Early Development of the Epiphysis and Paraphysis in Amia , J. Comp. Neurol. 7:45, 1897. 11. Kingsbury, B. F.: The Encephalic Evaginations in Ganoids , J. Comp. Neurol. 7:37, 1897. 12. von Kupfer, K.: Die Morphologie des Centralnervensystems , in Hertwig, O.: Handbuch der vergleichenden und experimentellen Entwicklungslehre der Wirbelthiere , Jena, Gustav Fischer, 1905, chap. 8, pt. 2. 13. Keibel, P., and Mall, F. P.: Manual of Human Embryology , Philadelphia, J. B. Lippincott Company, 1912 14. Warren13 (1917) 15. Bailey12 (1916) 16. Poirier, P., and Charpy, A.: Traité d'anatomie humaine , ed. 3, Paris, Masson & Cie, 1912, vol. 3, p. 49. 17. Ranson, S. W.: The Anatomy of the Nervous System , ed. 2, Philadelphia, W. B. Saunders Company, 1925, p. 31. 18. Ariëns-Kappers, C. U.: Die vergleichende Anatomie des Nervensystems der Wirbeltiere und des Menschen , The Netherlands, de Erven F. Bohn, 1921, vol. 2, p. 1031. 19. Bailey, P.: Morphology of the Roof Plate of the Forebrain and the Lateral Choroid Plexuses in the Human Embryo , J. Comp. Neurol. 26:79, 1916. 20. John Warren ( The Development of the Paraphysis and Pineal Region, in Mammalia , J. Comp. Neurol. 28:75, 1917 21. footnote 16c. 22. Sjövall.1 23. Byrom, F. B., and Russell, D. S.: Ependymal Cyst of the Third Ventricle , Lancet 2:278, 1932. 24. Beutler, A.: Ueber Ependymcysten im dritten Ventrikel als Todesursache , Virchows Arch. f. path. Anat. 232:358, 1921. 25. Rinder, C. O., and Cannon, P. R.: Impaction of a Neuro-Epithelial Cyst in the Third Ventricle of the Brain , Arch. Neurol. & Psychiat. 30:880 ( (Oct.) ) 1933. 26. Hassin, G. B., and Anderson, J. B.: Cystic Tumor of the Third Ventricle , U. S. Vet. Bur. M. Bull. 6:56, 1930. 27. Pollock ( Tumor of the Third Ventricle , J. A. M. A. 64:1903 [ (June 5) ] 1915) 28. H. Josephy ( Ueber einige seltene klinisch und anatomisch interessante Hirntumoren , Deutsche Ztschr. f. Nervenh. 74:234, 1922) 29. T. J. Putnam ( The Intercolumnar Tubercle: An Undescribed Area in the Anterior Wall of the Third Ventricle , Bull. Johns Hopkins Hosp. 33:181, 1922) 30. J. L. Pines ( Ueber ein bisher unbeachtetes Gebilde im Gehirn einiger Säugetiere: Das subfornicale Organ des III Ventrikels , J. f. Psychol. u. Neurol. 34:186, 1926) 31. Byrom and Russell.14b 32. Pollock.16a 33. Drennan.3a 34. Beutler.14c 35. Hall, A. J.: Two Cases of Colloid Tumor of the Third Ventricle, Causing Death , Lancet 1:89, 1913. 36. Fulton and Bailey.3b 37. Pollock.16a 38. Penfield, W.: Diencephalic Autonomic Epilepsy , Arch. Neurol. & Psychiat. 22:358 ( (Aug.) ) 1929. 39. Dandy's21a 40. Dandy, W. E.: Benign Tumors in the Third Ventricle of the Brain: Diagnosis and Treatment , Springfield, Ill., Charles C. Thomas, Publisher, 1933. 41. Masson.2 42. Stookey, B.: Intermittent Obstruction of the Foramen of Monro by Neuro-Epithelial Cysts of the Third Ventricle , Bull. Neurol. Inst. New York 3:446 ( (March) ) 1934. 43. Sjövall.1 44. Rinder and Cannon.14d 45. McLean, A. J.: Die Craniopharyngealtaschentumoren (Embryologie, Histologie, Diagnose und Therapie) , Ztschr. f. d. ges. Neurol. u. Psychiat. 126:639, 1930. 46. Zimmerman and German.3c 47. Byrom and Russell.14b 48. Rinder and Cannon.14d 49. Josephy.16b 50. Penfield 20 51. Weil ( Colloid Cyst of the Third Ventricle , Arch. Neurol. & Psychiat. 28:726 [ (Sept.) ] 1932) 52. Keschner and Savitsky, writing at a later date ( Tumors of the Third Ventricle , Arch. Neurol. & Psychiat. 33:216 [ (Jan.) ] 1935) 53. Stookey's21c 54. Masson.2 55. T. H. B. Bedford ( The Great Vein of Galen and the Syndrome of Increased Intracranial Pressure , Brain 57:1, 1934) 56. Ingalls, N. W.: Studies in the Pathology of Development: Some Aspects of Defective Development in the Dorsal Midline , Am. J. Path. 8:525, 1932. 57. Curtius, I.: Ueber den Status dysraphicus , Ztschr. f. d. ges. Neurol. u. Psychiat. 149:1, 1933. 58. Sjövall,1 59. H. G. Wells' volume entitled " Chemical Pathology " (ed. 4, Philadelphia, W. B. Saunders Company, 1920, p. 478). 60. Ramón y Cajal, S.: Histologie du système nerveux de l'homme et des vertébrés , Paris, A. Maloine, 1911, vol. 2, p. 303. 61. Eycleshymer and Davis 8 62. Kingsbury 9a 63. Johnston, J. B.: The Morphology of the Forebrain Vesicle in Vertebrates , J. Comp. Neurol. 19:457, 1909. 64. Turkewitsch, N.: Zur Entwicklung des Zwischenhirndaches beim Menschen: "Organon praecommissurale," Anat. Anz. 75:463, 1933. 65. Dandy.21a 66. Masson.2 67. Stookey.21c

MICHAEL, JOSEPH C.;LEVIN, PAUL M.

doi: 10.1001/archneurpsyc.1936.02260090067003pmid: N/A

Abstract The hereditary nature of certain vascular malformations has been established by the familial occurrence of telangiectasis of the skin and mucous membranes (Rendu1 and Osler2). Such abnormalities tend to be widespread and to occur in particular locations in the affected members of a family. The condition has thus been given various names, such as hereditary epistaxis and hereditary hematuria. In a similar way multiple telangiectatic nodules may occur in the central nervous system and also may be hereditary. We present the report of a family in which several members in two generations suffered from convulsive seizures. In two members multiple calcified lesions were seen in roentgenograms of the skull. Biopsy of one of the nodules revealed calcified and ossified telangiectasis of the brain. REPORT OF CASES Case 1. —The mother of three of the patients (cases 3, 4 and 5) began to have convulsive seizures at the age References 1. Rendu, M.: Epistaxis répétées chez un sujet porteur de petits angiomes cutanés et muqueux , Bull. et mém. Soc. méd. d. hôp. de Paris 13:731-733, 1896. 2. Osler, W.: On a Family Form of Recurring Epistaxis, Associated with Multiple Telangiectases of the Skin and Mucous Membranes , Bull. Johns Hopkins Hosp. 12:333-337, 1901. 3. Geyelin, H. R., and Penfield, W.: Cerebral Calcification Epilepsy: Endarteritis Calcificans Cerebri , Arch. Neurol. & Psychiat. 21:1020-1043 ( (May) ) 1929. 4. Kufs, H.: Ueber heredofamiliäre Angiomatose des Gehirns und der Retina, ihre Beziehungen zueinander und zur Angiomatose der Haut , Ztschr. f. d. ges. Neurol. u. Psychiat. 113:651-686, 1928. 5. Oppenheim, H.: Ueber klinische Eigentümlichkeiten kongenitaler Hirngeschwülste , Neurol. Centralbl. 32:3-10, 1913. 6. Fedoroff, H., and Bogorad, F.: Zur Klinik der Angiome des Grosshirns , Ztschr. f. d. ges. Neurol. u. Psychiat. 94:497-506, 1925. 7. Ohlmacher, A. P.: Multiple Cavernous Angioma, Fibroendothelioma, Osteoma, and Hematomyelia of the Central Nervous System in a Case of Secondary Epilepsy , J. Nerv. & Ment. Dis. 26:395-426, 1899. 8. Creite: Zur Pathogenese der Epilepsie (multiple Angiome des Gehirns mit Ossifikation) , München. med. Wchnschr. 50:1767-1770, 1903. 9. Claude, M. H., and Loyez, M.: Sur certaines angiectasies capillaires des centres nerveux , Rev. neurol. 22:181-187, 1911. 10. Huebschmann: Ueber einige seltene Hirntumoren (multiple Angiome, epithelialer Tumor, Lipom) , Deutsche Ztschr. f. Nervenh. 72:205-224, 1921. 11. Müller, H. H.: Ueber einen unter eigentümlichen Symptomen verlaufenden Fall von multiplen Hirnangiomen , Monatschr. f. Psychiat. u. Neurol. 53:243-250, 1923. 12. Malamud, W.: Ueber einen Fall von multiplen Hämangiom des Zentralnervensystems mit bemerkenswertem klinischen Verlauf , Ztschr. f. d. ges. Neurol. u. Psychiat. 97:651-671, 1925. 13. Berger, H., and Guleke: Ueber Hirntumoren und ihre operative Behandlung , Deutsche Ztschr. f. Chir. 203-204:104-167, 1927. 14. Smitt, W. G. S.: Angiomatosis van het centrale zenuwstelsel , Psychiat. en neurol. bl. 33:471-480, 1929. 15. Hosoi, K.: Multiple Intracranial Angiomas , Am. J. Path. 6:235-243, 1930. 16. Russell, Dorothy S., in discussion on symposium on Vascular Tumors of the Brain and Spinal Cord , Proc. Roy. Soc. Med. 24:363-388, 1930. 17. Roussy, G., and Oberling, C.: Les tumeurs angiomateuses des centres nerveux , Presse méd. 38:179-185, 1930. 18. della Torre, P. L.: Angiomi venosi multipli del lobo frontale , Riv. di neurol. 6:167-176, 1933. 19. Virchow, R.: Ueber die Erweiterung kleinerer Gefässe , Virchows Arch. f. path. Anat. 3:427-462, 1851. 20. Jaffé, R. H.: Multiple Hemangiomas of the Skin and of the Internal Organs , Arch. Path. 7:44-54 ( (Jan.) ) 1929. 21. Reitano, R., and Loi, L.: Focolai osteomielopoietici in una formazione telangectasica del nucleo caudato , Arch. ital. di anat. e istol. pat. 5:353-370, 1934. 22. Oberndorfer: Verkalkungs- und Verknöcherungsherde im Gehirn , Verhandl. d. deutsch. path. Gesellsch. 15:316-318, 1912. 23. Cushing, H., and Bailey, P.: Tumors Arising from the Blood-Vessels of the Brain: Angiomatous Malformations and Hemangioblastomas , Springfield, Ill., Charles C. Thomas, Publisher, 1928. 24. Lindau, A.: Studien über Kleinhirncysten—Bau, Pathogenese und Beziehungen zur Angiomatosis retinae , Acta path. et microbiol. Scandinav. ( (supp.) ) 1:1-128, 1926. 25. Levin, P. M.: Multiple Hereditary Hemangioblastomas of the Nervous System , Arch. Neurol. & Psychiat. 36:384 ( (Aug.) ) 1936. 26. Bailey, P.: Concerning Diffuse Pontine Gliomas in Childhood, Acta neuropath. in honorem L. Puusepp, 1935, pp. 199-214. 27. Courville, C. B., and Adelstein, L. J.: Intracranial Calcifications, With Particular Reference to That Occurring in the Gliomas , Arch. Surg. 21:801-828 ( (Nov.) ) 1930. 28. Fritzsche, R.: Eine familiär auftretende Form von Oligophrenie mit röntgenologisch nachweisbaren symmetrischen Kalkablagerungen im Gehirn, besonders in den Stammganglien , Schweiz. Arch. f. Neurol. u. Psychiat. 35:1-29, 1935.

SWANK, ROY L.

doi: 10.1001/archneurpsyc.1936.02260090083004pmid: N/A

Abstract Knowledge of the pyramidal system is incomplete and confused because too much reliance has been placed on study of normal histologic material rather than on critical experimental methods. This is especially true of the rabbit. According to Linowiecki,1 the pyramidal tract of the rabbit is located in the lateral funiculus of the spinal cord. His conclusion was based on work of Lenhossék,2 Bechterew3 and Münzer and Wiener4 and was strengthened not by experiments but by his own study of normal material. Lenhossék's and Bechterew's sections stained with the Weigert method from normal new-born rabbits exhibited an area in the dorsal part of the lateral funiculus from which myelin was absent, and the authors assumed this area to be in the position of the corticospinal tract. Münzer and Wiener employed both normal histologic preparations and degenerating postoperative material stained by the Marchi technic. On the basis of References 1. Linowiecki, A. J.: The Comparative Anatomy of the Pyramidal Tract , J. Comp. Neurol. 24:509, 1914.Crossref 2. Lenhossék, M.: Ueber die Pyramidenbahnen im Rückenmarke einiger Säugetiere , Anat. Anz. 4:208, 1889. 3. Bechterew, W.: Ueber die verschiedenen Lagen und Dimensionen der Pyramidenbahnen beim Menschen und den Thieren und über das Vorkommen von Fasern in denselben welche sich durch eine frühere Entwickelung auszeichnen , Neurol. Centralbl. 9:738, 1890. 4. Münzer, E., and Wiener, H.: Das Zwischen- und Mittelhirn des Kaninchens und die Beziehungen dieser Teile zum übrigen Centralnervensystem , Monatschr. f. Psychiat. u. Neurol. 12:241, 1902.Crossref 5. Van der Vloet: Ueber den Verlauf der Pyramidenbahn bei niederen Säugetieren , Anat. Anz. 29:113, 1906. 6. Simpson, S.: The Motor Areas and Pyramid Tract in the Canadian Porcupine , Quart. J. Exper. Physiol. 8:79, 1915. 7. Brouwer, B.: Centrifugal Influence on Centripetal Systems in the Brain , Arch. Neurol. & Psychiat. 30:456 ( (Aug.) ) 1933. 8. Ferrier, D.: The Functions of the Brain , London, Smith, Elder and Co., 1886. 9. Mills, W.: I. The Functional Development of the Cerebral Cortex in Different Groups of Animals; II. The Psychic Development of Young Animals and Its Physical (Somatic) Correlation with Special Reference to the Brain; III. Cortical Cerebral Localization with Special Reference to Rodents and Birds , Tr. Roy. Soc. Canada 2:3, 1896. 10. Allen, W. F.: Location in the Spinal Cord of Pathways Which Conduct Impulses from the Cerebrum and Superior Colliculus, Affecting Respiration , J. Comp. Neurol. 43:451, 1927. 11. Laughton, N. B.: Studies on the Occurrence of Extensor Rigidity in Mammals as a Result of Cortical Injury , Am. J. Physiol. 85:78, 1928. 12. Swank, R. L., and Davenport, H. A.: Marchi's Staining Method: Studies of Some of the Underlying Mechanisms Involved , Stain Technology 9:11, 1934 13. A solution of Dial-Ciba was obtained from the Ciba Company, Inc., New York City. 14. The term "pyramidal tract" is used here to designate all fibers coursing in the cerebral peduncles and pyramids regardless of whether their origin is cortical or subcortical. 15. Swank, R. L.: Aberrant Pyramidal Fascicles in the Cat , J. Comp. Neurol. 60:355, 1934. 16. Swank, R. L.: The Relationship Between the Circumolivary Pyramidal Fascicles and the Pontobulbar Body in Man , J. Comp. Neurol. 60:309, 1934 17. footnote 15. 18. Bremer, F.: Physiologie nerveuse de la mastication chez le chat et le lapin. Reflexes de mastication. Responses masticatoires corticales et centre cortical du goût , Arch. internat. de physiol. 21:308, 1923. 19. Magoun, A. W.; Ranson, S. W., and Fisher, C.: Corticofugal Pathways for Mastication, Lapping and Other Motor Functions in the Cat , Arch. Neurol & Psychiat. 30:292 ( (Aug.) ) 1933. 20. Wallenberg, A.: Bemerkenswerte Endstätten der Grosshirnfaserung bei Säugern , Jahrb. f. Psychiat. u. Neurol. 51:295, 1934. 21. Wilson, S. A. K.: An Experimental Research into the Anatomy and Physiology of the Corpus Striatum , Brain 36:427, 1914. 22. Morgan, L. O.: The Corpus Striatum: A Study of Secondary Degeneration Following Lesions in Man and of Symptoms and Acute Degenerations Following Experimental Lesions in Cats , Arch. Neurol. & Psychiat. 18:495 ( (Oct.) ) 1927. 23. Bechterew, W.: Die Funktionen der Nervencentra , Jena, Gustav Fischer, 1909. 24. Magnus, R.: Körperstellung , Berlin, Julius Springer, 1924. 25. King, J. L.: The Pyramid Tract and Other Descending Paths in the Spinal Cord of the Sheep , Quart. J. Exper. Physiol. 4:133, 1911. 26. Turner, E. L.: The Pyramidal Tract of the Virginian Opossum , J. Comp. Neurol. 36:387, 1924. 27. Gray, P. A., Jr., and Turner, E. L.: The Motor Cortex of the Opossum , J. Comp. Neurol. 36:375, 1924.Crossref 28. Rogers, F. T.: An Experimental Study of the Cerebral Physiology of the Virginian Opossum , J. Comp. Neurol. 37:265, 1924.Crossref 29. Weil, A., and Lassek, A.: The Quantitative Distribution of the Pyramidal Tract in Man , Arch. Neurol. & Psychiat. 22:495 ( (Sept.) ) 1929. 30. Lassek, A. M.; Dowd, L. W., and Weil, A.: The Quantitative Distribution of the Pyramidal Tract in the Dog , J. Comp. Neurol. 51:153, 1930. 31. King, J. L.: The Corticospinal Tract of the Rat , Anat. Rec. 4:245, 1910. 32. Lassek, A. M.: A Comparative Volumetric Study of the Gray and White Substance of the Spinal Cord . J. Comp. Neurol. 62:321 ( (Oct.) ) 1935. 33. DeLozier, L. C.: A Comparative Study of the Lateral Reticular Nucleus in the Upper Three Cervical Spinal Cord Segments , Anat. Rec. 55:53, 1933. 34. Malone, E. F.: Recognition of Members of the Somatic Motor Chain of Nerve Cells by Means of a Fundamental Type of Cell Structure, and the Distribution of Such Cells in Certain Regions of the Mammalian Brain , Anat. Rec. 7:67, 1913.

McKENZIE, K. G.

doi: 10.1001/archneurpsyc.1936.02260090095005pmid: N/A

Abstract This presentation refers particularly to the treatment of glioblastoma which can be verified at operation or, if necessary, definitely identified by an immediate microscopic examination. The conclusion which I have reached in regard to surgical treatment is at variance with the view held by some neurosurgeons in America and probably also by some in England. A few years ago I formed the opinion that operation was futile and better left undone if one could be reasonably certain of the diagnosis preoperatively. I think otherwise at the present time. The former impression developed because of a number of surgical experiences exemplified by the following case: Case 1. —A well educated man aged 45 had a short history of intracranial pressure. Operation showed that the frontal convolutions were flattened and pale, and a deep glioblastoma was verified by incising the cortex and removing a small amount of tumor. A sufficient mass of

KING, LESTER S.;MEEHAN, MARJORIE C.

doi: 10.1001/archneurpsyc.1936.02260090100006pmid: N/A

Abstract Extensive primary degeneration of the corpus callosum has been described in about forty male Italians. Since Marchiafava and Bignami1 reported the first three cases on record, in 1903, the condition has usually been called Marchiafava's disease. It is characterized by demylinization of nerve fibers, with relative retention of axis-cylinders; the lesions occur invariably in the corpus callosum, but sometimes in other parts of the brain as well. These lesions are symmetrically located on the two sides of the brain. In cases in which a clinical history has been obtained the symptoms were found to be both psychic and somatic. The patients were usually in or past middle age and frequently had been excessive users of alcohol. In the present report we shall record an additional case. HISTORY In 1903 Marchiafava and Bignami1 reported briefly the observations at autopsy in three cases, one of which had first been described References 1. Marchiafava, E., and Bignami, A.: Sopra un' alterazione del corpo calloso osservata in soggetti alcoolisti , Riv. di pat. nerv. 8:544, 1903. 2. Bignami, A.: Sulle alterazione del corpo calloso e della commissura anteriore ritrovate in un alcoolista , Policlinico (sez. prat.) 14:460, 1907. 3. Rossi, O.: Sull 'istologia patologica di una speciale alterazione descritta da Marchiafava nel corpo calloso degli alcoolisti , Riv. di pat. nerv. 15:346, 1910. 4. Marchiafava, E.; Bignami, A., and Nazari, A.: Ueber System-Degeneration der Kommissurbahnen des Gehirns bei chronischen Alkoholismus , Monatschr. f. Psychiat. u. Neurol. 29:181 and 315, 1911.Crossref 5. Cesaris-Demel: Atti d. Soc. ital. di pat. in Pisa. 1913. 6. Giannelli, in Mingazzini, G.: Lezioni di anatomia clinica dei centri nervosi , Turin, 1912. 7. Marchiafava, E.: Conferenza sulla patologia dell' alcoolismo , Milano, 1913. 8. Sarteschi: Sopra una speciale alterazione della sostanza bianca in un caso di alcoolismo cronico , Riv. sper. di freniat. 37:115, 1911. 9. Bignami, A., and Nazari, A.: Sulla degenerazione delle commissure encefaliche e degli emisferi nell' alcoolismo cronico , Riv. sper. di freniat. 41:81, 1915. 10. Guccione ( Su un caso di degenerazione primaria del corpo calloso , Riv. di pat. nerv. 34:722, 1929) 11. Bignami, A., and Nazari, A.: Sulla degenerazione delle commissure encefaliche e degli emisferi nell' alcoolismo cronico , Riv. sper. di freniat. 41:81, 1915. 12. Milani, A.: Patologia del corpo calloso, Tesi di Lib. Doc. nella R. Univ. di Roma, 1914. 13. Mingazzini, G.: Der Balken , Berlin, Julius Springer, 1922. 14. Guccione, F.: Su un caso di degenerazione primaria del corpo calloso , Riv. di pat. nerv. 34:722, 1929. 15. Marchiafava, E.: The Degeneration of the Brain in Chronic Alcoholism , Proc. Roy. Soc. Med. 26:1151, 1933. 16. The age of Guccione's patient was once stated as 32 and once as 82. Evidently the first figure is a typographical error, as internal evidence suggests that 82 is correct. 17. Tuthill, C. R., and Beck, G. M.: Reaction of Cerebral Tissue to Direct Injection of Oil , Arch. Neurol. & Psychiat. 29:1263 ( (June) ) 1933. 18. King, L. S.: Vital Staining of Microglia , Arch. Path. 19:656 ( (May) ) 1935. 19. D'Abundo, G.: Sopra una particolare neuropatia spasmodica con disturbo del linguaggio articolato , Riv. ital. di neuropat. 10:233, 1917. 20. Putnam, T. J.: Personal communication to the authors, 1935; Studies in Multiple Sclerosis: IV. "Encephalitis" and Sclerotic Plaques Produced by Venular Obstruction , Arch. Neurol. & Psychiat. 33:929 ( (May) ) 1935 21. VII. Similarity Between Some Forms of "Encephalomyelitis" and Multiple Sclerosis , Putnam Arch. Neurol. & Psychiat. 35:1289 ( (June) ) 1936 22. Etiologic Factors in Multiple Sclerosis , Ann. Int. Med. 9:854 ( (Jan.) ) 1936. 23. Putnam, T. J.: Personal communication to the authors.

TSANG, YÜ-CHÜAN

doi: 10.1001/archneurpsyc.1936.02260090122007pmid: N/A

Abstract Wounds, foreign bodies, dead cells and other injurious agents usually induce reactions in a bodily tissue in which blood vessels with their contents play a leading rôle. Small blood vessels, including capillaries, are dilated and have an increased flow of blood. The permeability of the walls of the vessels is heightened, so that liquid from the blood penetrates the crevices of the surrounding tissue and leukocytes pass through the endothelial wall and approach—together with histogenous wandering cells—the affected region. Capillaries increase in number through "budding." All these changes imply a "protective" and "defense" mechanism to clear the site of injury and start repair.1 This holds in a different degree for all kinds of bodily tissues. Some neurologists (von Monakow,2 Campbell3 and others) consider that the brain tissue is an outstanding exception to this general rule. The disturbing effect of an injury to the brain is supposed to References 1. MacCallum, W. G.: Text-Book of Pathology , ed. 5, Philadelphia, W. B. Saunders Company, 1932. 2. von Monakow, C.: Gehirnpathologie , ed. 2, Vienna, Hölder-Pichler-Tempsky, 1904. 3. Campbell, A. W.: Histological Studies on the Localization of Cerebral Function , London, Cambridge University Press, 1905. 4. Tilney, F., and Riley, H. A.: The Form and Functions of the Central Nervous System , ed. 2, New York, Paul B. Hoeber, Inc., 1923. 5. Tsang, Y. C.: Vascular Changes Following Experimental Lesions in the Cerebral Cortex , Arch. Neurol. & Psychiat. 85:1280 ( (June) ) 1936. 6. Pfeiffer, R. A.: Die Angioarchitektonik der Grosshirnrinde , Berlin, Julius Springer, 1928 7. Grundlegende Untersuchungen für die Angioarchitektonik des menschlichen Hirns , Berlin, Julius Springer, 1930. 8. Tsang, Y. C.: The Blood Supply of the Lateral Geniculate Body in the Rat , J. Comp. Neurol. 61:553 ( (June) ) 1935. 9. Hassin, G. B.: Histopathology of the Peripheral and Central Nervous System , Baltimore, William Wood & Company, 1933. 10. Maximow, A. A., and Bloom, W.: Text-Book of Histology , ed. 1, Philadelphia, W. B. Saunders Company, 1930. 11. Pfeiffer.6 12. Hassin.8 13. Hassin.8 14. MacCallum.1

BATEMAN, J. FREMONT

doi: 10.1001/archneurpsyc.1936.02260090131008pmid: N/A

Abstract Changes in 178 brains of persons who had had convulsions are reviewed. Gross pathologic change was demonstrated in 174 of the brains and anomalous blood vessels in 2, and 2 were considered to be normal. In 34 cases in the series a clinical diagnosis other than idiopathic epilepsy was made and substantiated. In this group of cases the following clinical and pathologic conditions were observed: tumor of the brain, in 1 case; syphilitic meningo-encephalitis, in 6 cases; meningitis (all types), in 21 cases; traumatic encephalitis, in 2 cases; encephalitis, in 3 cases, and alcoholism, in 1 case. A diagnosis of epilepsy with some degree of amentia or dementia was made in the remaining 146 cases. In this group of cases of idiopathic epilepsy in which no clinical diagnosis was made, the pathologic observations were as follows: In the group of 146 cases of idiopathic epilepsy, the cause of the convulsions References 1. Bateman, J. Fremont: (a) Closed Foramina of Luschka in the Brains of the Insane: Their Influence on the Pathogenesis of the Psychoses , Arch. Neurol. & Psychiat. 14:616 ( (Nov.) ) 1925 2. Obstructions in the Pathway of the Cerebro-Spinal Fluid, Proceedings of the Fifth Annual Convention of the Central Neuropsychiatric Association of Ohio, Cincinnati, October 1926 3. Meningitis with Special Reference to the Rôle of the Pacchionian Bodies , Ohio State M. J. 25: 970 ( (Dec.) ) 1929. 4. Fay, Temple: (a) Epilepsy: Clinical Observations on the Control of Convulsive Seizures by Means of Dehydration , J. Nerv. & Ment. Dis. 71:481 ( (May) ) 1930 5. Generalized Pressure Atrophy of the Brain, Secondary to Traumatic and Pathologic Involvement of Pacchionian Bodies , J. A. M. A. 94: 245 ( (Jan. 25) ) 1930. 6. Winkelman, N. W., and Fay, Temple: The Pacchionian System: Histologic and Pathologic Changes with Particular Reference to the Idiopathic and Symptomatic Convulsive States , Arch. Neurol. & Psychiat. 23:44 ( (Jan.) ) 1930. 7. Papez, James W.: Comparative Neurology: A Manual and Text for the Study of the Nervous System of Vertebrates , New York, Thomas Y. Crowell Company, 1929.

BRICKNER, RICHARD M.

doi: 10.1001/archneurpsyc.1936.02260090139009pmid: N/A

Abstract A symptom which appears not to have been previously described was observed in a recent study of sixty-two cases of multiple sclerosis.1 It is common in multiple sclerosis, and yet the first person in whom it was noted and who came to autopsy did not have multiple sclerosis but another disease. The name oscillopsia is suggested for the symptom. Oscillopsia means, literally, oscillating vision. The patient complains that objects seem to move back and forth, to jerk or to wiggle. The oscillation usually occurs only during walking, although occasionally it also manifests itself during fixation of gaze at rest. Most commonly it applies to near and distant objects equally. The motion may be in any direction, although the lateral component is usually the most prominent. It is well known that nystagmus may produce an oscillating visual sensation in persons with conditions of many types and that the same phenomenon References 1. Brickner, Richard M.: Bull. Neurol. Inst. New York 5:16, 1936.

SCOTT, MICHAEL;PIGOTT, ALBERT W.

doi: 10.1001/archneurpsyc.1936.02260090143010pmid: N/A

Abstract A review of the literature on the calcium content of the blood serum during an epileptic convulsion reveals no adequate series of cases with the values based on an accepted method. Determinations of the calcium content between seizures have been made by many workers. The values usually fall within normal limits. Bigwood,1 Parhon and Ornstein,2 and Di Renzo and Tomasino3 reported values lower than normal, while others, namely, Patterson4 and Hernandez del Valle,5 reported levels above the upper limit of normal. A study of the calcium content of the blood serum has been made on a series of fifty unselected, nonfasting patients with chronic epilepsy at the New Jersey State Village at Skillman. Blood was removed for determination of its calcium content during a major convulsive seizure and subsequently, from the same patients, between attacks. METHOD The specimens were taken between 1: 45 and 2: References 1. Bigwood, E. J., cited by Lennox, W., and Allen, Margaret B.: Studies in Epilepsy: XI. The Calcium Content of the Blood and of the Spinal Fluid , Arch. Neurol. & Psychiat. 24:1199 ( (Dec.) ) 1930. 2. Parhon, C. L., and Ornstein, J.: On the Calcium of the Blood and Spinal Cord in Epilepsy as Well as in Certain Psychoses , Bull. et mém. Soc. méd. d. hôp. de Paris 54:742, 1930. 3. Di Renzo, F., and Tomasino, A.: Research on the Behavior of Calcium and Potassium in the Blood of Epileptics in the Period Between Attacks and During Attacks , Rassegna di studi psichiat. 19:503, 1930. 4. Patterson, H. A.: Some Observations on Blood Calcium Content in Epilepsy and the Convulsive States , Baltimore, Williams & Wilkins Company, 1931, vol. 7, pt. 1, p. 387. 5. Hernandez del Valle, P.: Calcium Content of Blood and Cerebrospinal Fluid: Potassium Content of Blood in Epileptics , Arch. cardiol. y hemat. 14:150 ( (April) ) 1933.