PUNCTATE A.ND CAPILLARY.—These are sufficiently explained. by the terms. Of themselves they are rarely of suffi cient moment to be of other than patho logical interest.
Symptoms.—P RODROMATA. — Th e so called premonitory symptoms include headache, dizziness, pallor or flushing of the face, fullness in the head, flicker ing before the eyes, visual obscuration, poor sleep, tinnitus aurium, thickness of the tongue, numbness or peculiar tinglings of one side of the body, heavi ness of extremities, slight mental changes,—as lapses of memory, drowsi ness, and irritability,—changed, slowed, or intermittent pulse, etc. These, when occurring in an elderly person, are thought by many physicians to point to an impending hmmorrhage. There is no doubt that such symptoms fre quen'tly precede thrombosis. This fact, together with the lack of adequate pathological proof and inability to ac count for premonitions in hcemorrhage, has caused a, disinclination among con servative observers to recognize any con nection of the kind. In some cases, however, there may be a preliminary oozing sufficient to produce slight symp toms. Further the evidence of a vaso motor influence suggests that a local paralysis of vessels with sufficient dila tation to irritate the adjacent tracts may precede the actual rupture. This, how ever, in a few days ends in a frank at tack of apoplexy. In the aged most of these symptoms point rather to throm bosis; but in earlier years they may give warning of incipient limmorrhage.
Constipation is common in the pro dromal stage, but is too usual a matter to have any diagnostic significance. Turgidity of the vessels of the head, severe pain in the head, convulsive twitchings of an extremity (Jacksonian), I unilateral chorea, etc., are rare, and be long to the initial stage of apoplexy—or, of course, more often its later stages.
symptoms that may mark the onset of the attack include the vari ous prod.romata just mentioned; also faintness or general prostration, convul sive movements, aphasia, paralysis, stu por and even unconsciousness, free per spiration; slow, tense pulse, etc.
Tbe regularity and the sequence with which these appear are very variable. In fulminant attacks the severest symp- A toms may promptly develop, and even death itself be not long delayed. Sud den death may occur if the trouble is in the pons. Oftener there is a gradual in crease, both in the number and the se severity of the manifestations, for some little time: one, two, three, or more hours.
often there is no special complaint of pain in the head, and again headache has been such an habitual thing with the patient that lit tle importance can be attached to it. Nephritic complications, when present, tend also to rob this symptom of value.
In many cases, however, there is head ache, severe, deep, and general in char acter, less often localized. It becomes more pronounced as the effusion in creases in volume, and, even when the consciousness has become more or less obscured, the sufferer may persist in put ting a hand to the head, evidently be cause some degree of pain or distress is still perceived. When, therefore, we meet a headache unusual to the patient, excruciating in character, not otherwise explicable, and associated with suggestive phenomena, it acquires some value as a symptom.
A losv, occipital pain is common in cases of cerebellar apoplexy; but as it may be due to other causes its only sig nificance comes from association.
Vomiling.—This is a common symp tom and one of much. clinical impor tance, its value, however, depending much on the certainty with which urmmia can be excluded. Nausea may, of course, attend dizziness, faintness, or thrombosis; but actual vomiting, aside from urmmia (especially if the person is reclining), argues, in a suspicious case, for Inemorrliag-e. This applies to the increasing period of the effusion.
[it has been claimed to be especially frequent in cerebellar limmorrhage, but, as stated, it is common in all forms. W.