GROUP V. PSYCHOSES DUE TO GROSS LESION IN THE BRAIN.
Under the term organic dementia authors describe those forms of insanity due to destruction of areas of brain tissue following syphilitic deposits, ab scesses, hemorrhagic infarctions, tumors, aneurisms, and cranial traumatisms.
Syphilitic Insanity.
Definition.—Insanity due to syphilitic new formation in the brain or meninges.
Symptoms. — Severe and long-con tinued headache, more intense usually at night, frequently precedes any psychical manifestations. Attacks of unconscious ness, sometimes convulsions and coma, are not rare. After one of these attacks there is frequently local or general pa ralysis, which may be transitory or per manent. Ptosis is a frequent symptom. Halting speech and actual aphasia may also occur.
Stupor and depression may alternate with maniacal outbreaks. The memory is often profoundly impaired, the patient forgetting even his own name, business. and place of residence. In many cases the symptoms resemble so closely those of general paresis, including delusions of grandeur, that a differential diagnosis is impossible during life. In most cases, however, the motor disturbances are of a more distinctly paralytic character, com plete loss of power of certain muscular groups being more frequent than in gen eral paresis. In advanced stages the de mentia is usually profound.
Diagnosis.—This must depend largely upon the history. The presence of evi dences of syphilis in other organs; sud den attacks of aphasia, following apo plectic or epileptiform seizures ; hemi plegia and ptosis, with the psychical symptoms above mentioned, will permit a probable diagnosis to he made in the majority of eases. As stated, however, a positive differentiation from general paresis is often impossible during life.
Conclusions based on a study of syph ilis in its relation to insanity summed up in the form of a suggestion for a provisional scheme of classification as follows:— I. Insanity of early syphilis (primary and secondary).
1. Acute toxic insanity (analogous to delirium or mania a potu).
2. Melancholia with or without de mentia, probably due to cerebral a namnia IT. Insanity of late (tertiary) syphilis.
1. Insanity clue to syphilitic disease of the base and vessels.
2. Insanity due to syphilitic disease of the convexity.
Most, if not all, cases of cerebral syph ilis in which insanity has been caused by epilepsy will fall under the second head (II, 2), but should rather be classed with epileptic insanity. being only indi rectly due to syphilis.
III. liletasyphilitic (parasyphilitic) in sanity.
1. Insanity of tabes (so far as clue to other than "moral" causes).
2. General paralysis of the insane.
This classification only includes eases in which there is certainly, or probably, a gross anatomical change at the basis of the mental symptoms. But it is ob vious that there are various indirect ways in which a disease like syphilis may produce morbid action in unstable minds. Such are the fear of contracting the disease; the worry, remorse, and anxiety produced by its existence; and the pain and insomnia and other sensory symptoms so common in its course. With this class of cases, as being but the indirect result of the disease, and in no way peculiar, no attempt has been made to deal. W. E. Dawson (•our. Mental Science, Apr., '98).
Syphilitic dementia has nothing char acteristic about it, except that it is due to syphilis. There may be incoherent hebetude, simple depression, paralyses of the cranial nerves, apathy, anmmia, headache, clonic convulsions, eruptions, or bony lesions. Dementia may follow partial, paralytic, aphasic, or cephalalgic epilepsy, or it may occur without symp toms. Other signs of syphilis may or may not be found. Hirtz (Jour. des Praticiens, Aug. 30, 1902).
Pathological Anatomy.—The syphi litic neoplasm may be in the form of a diffused gummatous meningitis, endar teritis, or gummatous foci in the brain. Meningitis may also result from gum matous osteitis of the cranial bones.