THROMBOSIS. — Against thrombosis speak: youth unless the patient be a syphilitic, coincident or early rise of bodily temperature, early and deep coma, vomiting, great inequality of the pupils, high barometric pressure at time of onset, beginning of attack- when the per son is under effort or excitement, a pulse of high tension, the absence of prodro mata, and the existence of vigorous gen eral health.
PsEunosEtzunEs.—The question of a pseudo-attack can only arise where the subject is also suffering from either pro gressive dementia, tabes, disseminated sclerosis, or possibly the results of alco holism.
The other possibilities can be ex cluded more readily and on general lines.
Case of cortical luemorrhage with rupture into the lateral ventricle in which two symptoms were at variance witlt authoritative statements: 1. Dif ference of temperature between two a ; paralyzed side 1.2° lower. 2. Conjugate deviation of the bead and eyes toward the right (the paralyzed) side. Rigidity of arm on paralyzed side pres ent. H. A. lloyster (N. Y. "Med. Record, ! Dec. 7, '95).
The absence of glyeosnria. in a doubt fill case is inconclusive, but its presence points to a eerebral heemorrhage, doubt less aecompanied by invasion of the ven tricles. M. A. Robin and W. G. Kuss (La 11.4d. Mod.. No. 111., p. 481. '97).
Following conclusions reached from study of eight cases of cerebral hmmor rhage, embolism, and thrombosis; 1. In eases of hcmiplegia from cerebral hem orrhage which terminate fatally, large Immorrhages are not frequently found in the retina on the same side as the brain lesion, while no heemorrhages are pres ent in the opposite retita. 2. In cerebral embolism the same retinal condition is occasionally met witb; also in cerebral embolism occasionally the retinal vessels are slightly dilated on the side of the brain-lesion. 3. In thrombosis of the middle cerebral artery, when the throm bosis extends down into the internal caro tid, the vessels of the retina on the side of the brain-lesion may be markedly di lated and tortuous, while the retinal ves sels of the other eye are normal. R. T.
Williamson (Brit. Med. Jour. June 11. '98).
The term apoplexy is still loosely used even by the best writers. Cerebral arterial disease is almost never due to vascular involvement of the brain, ex cepting when the cardiac or respiratory centers are involved. Sudden death is almost always due to heart disease. A diagnosis between cerebral limorrhage and thrombosis is desirable, but impos sible. In heetnorrhage the treatment should be directed to lower vascular pressure, while in thrombosis exactly the opposite line of procedure should be employed. H. N. Moyer (Amer. Medicine, May 25. 1901).
Etiology.—The immediate cause of the hannorrhage is, of course, the rupt ure of some vessel, usually an artery, hut occasionally a vein. Back of these vascular changes we come to the real cattses that interest the practitioner. And here there is a broad distinction between senile conditions and those other factors that may be active at any period of life. In the young a considerable propor tion of the rare cases is due to the rupt ure of some single large aneurism in the vessels of the pia; as to their etiology, little is known. Except for these and be fore the advent of senility we find either nephritis, syphilis, local softening, trau matism, abnormal blood-conditions, or possibly certain nervous influences as the predominant causes.
Aliliary aneurisms have much less to do with its causation than has previ onsly been held, and, apart from mechan ical causes, such as trauma, etc., 'tremor rhage of the brain is most frequently tine to disease of the vessels that causes a loss of elasticity in their Typical miliary aneurisms are rare, but ather omatous and sypbilitie changes of the vascular walls play a very extensive rble. Mechanical causes arc more common than is commonly held to be the ease in produeing luemorrbage, without any real arterial disease suflieient of itself to produce it. L. Stein (Dent. Zeit. f. Nervenh., vol. vii, p. 313, '95).