A bruit will generally be heard over the sac and along the artery, but, like the pulsation, will be detected with vary ing distinctness according to the portion of the sac examined.
Pain may be an early symptom of aneurism; it is more commonly found in the second stage, when it may be sharp and lancinating or resemble the aching or boring of ulceration. It is due to the pressure produced by the tumor on the nerves, and is consequently intense in popliteal aneurism along the course of the popliteal nerve, which is, at times, flattened out upon the tumor.
Case in which there was no pain: a very constant symptom in thoracic aneurism. Nevertheless, the face flushed when the head was lowered, there was tracheal tugging; no fremitus could be felt over the left side of the chest: there was no pulsation in the left carotid, and the radial pulse on the left side was small. The loss of fremitus is one of the earliest signs of aneurismal pressure. Glynn (Brit. Med. Jour., Feb. 6, '97).
If located in one of the extremities. oedema of the limb constantly occurs after the aneurism has reached a cer tain size. It is due to pressure upon the veins, and may not only be painful. but also terminate in ulceration and slough ing.
Gangrene is a late symptom and may suddenly be caused by an embolus. Usu ally it is due to excessive oedema.
An aneurism may press upon various organs. If bone is compressed the pain is boring and gnawing, and results in the absorption of the osseous tissue.
Glands may, through this cause, cease their functions.
Compression of the trachea causes dif ficulty in respiration; of the oesophagus, trouble in swallowing. If the thoracic duct is interfered with, nutrition is im paired.
A peculiar brassy cough is produced by compression of the recurrent laryn geal nerve. Hiccough is frequently a result of pressure on the phrenic nerve, while marked capillary congestion may be caused by pressure on the sympathetic nerve.
Intracranial aneurism may give rise to hemiplegia, facial paralysis, deafness, ptosis, blindness, or strabismus, caused by pressure on various nerves.
Case of aneurism of the middle cere bral artery in a male 65 years of age. The attack had begun with a very marked vertigo. Soon after he was dis covered he became speechless. Breathing was very slow and irregular, and face was flushed. Both pupils were con tracted, the right one slightly more than the left. Paralysis of the left side, which gradually increased and extended to the left leg. Death on the second day. On autopsy, very decided hardness of the middle cerebral artery found, and an aneurismal sac dissected out, vlueh measured one centimetre in length and one-half centimetre in diameter, and was ovoid in shape. On first examina tion it had closely resembled an ordinary cerebral hmmorrhage. T. M. Prudden (Med. Record, Nov. 13, '97).
Differential Diagnosis.