PARALYSIS.
Psychical symptoms of general nature are not infrequent. Occasionally large tumors will cause a Korsakow syndrome. Catatonia may also appear. Sensory phenomena are frequent in postcentral convolution tumors. Central convolution tumors are among those more readily localizable, and usually more accessible to operative relief.
Parietal When the tumors press forward toward the posterior central lobes sensory signs are produced. Left-sided tumors, in right-handed persons, especially of the in ferior parietal lobes, cause cortical sensory aphasia of Wernicke of various grades. Alexia and agraphia may also be found in left-sided lesions.
Epileptic attacks with hallucinatory auras Of taste occur; also a general Korsakow syn drome may develop. Other pathways from the sensory areas may be cut off by tumors in this region; hence either hemianopsias, optic ag nosias or optical aphasias (gyres angularis). Apractic disturbances are of value in localizing left-sided tumors. Katatonic syndromes, con fusion, apathy or general loss of orientation may he encountered but are equally present in right-sided and left-sided cases.
Occasionally parietal tumors give rise to ptosis, paresis of the lateral movements of the head and the conjugate motion of the eyes to the opposite side. Deep-seated lesions may impinge upon or involve the motor pathways.
Temporal cortical end sta tions of the auditory pathways which are both crossed and uncrossed are chiefly contained in the first and second temporal lobes. Cortical deafness is practically impossible in unilateral lesions but has resulted from bilateral involve ment. Word-deafness is the most striking result in left-sided lesions. This is a progres sive affair, often beginning with difficulty in finding words, paraphasia, and resulting in more severe forms in alexia, agraphia, log orrhoea and total word-deafness. Large tumors also cause indirect symptoms and may lead, by pressure on motor areas, to total aphasia and epileptiform convulsions. Auditory hallucina tions are not infrequent, showing as aura in generalized grand mal attacks. Gustatory and olfactory phenomena of similar nature result from hippocampal or closely related lesions uncinate fits. Tumors of the under surface may cause hemianopsia, through pressure on the optic tracts, and by pressure on the pyramidal or fillet tracts cause hemiparesis or hemianles thesia.
Occipital end-projections of the optic tracts are located here particularly in and about the calcarine fissure. Complete
homonymous hemianopsia is the chief symptom of tumors of this area. This hemianopsia usually spares the papillomacular bundles and is often unperceived by the patient. Quadrant hemianopsia is also found. Tu mors may exist and hemianopsia be ab sent. It is most often present with tumors of the median aspect of the occipital, also with those lying on the convex surface, and hence the more readily removable. Various stages of blindness may also result, and there may exist a mind-blindness from left-sided tumors, also alexia, agraphia and sensory aphasia. Tumors on the inferior surface, by compression of the cerebellum, will cause cerebellar signs, and occasionally palsies result from tumors lying on the external surface of the occipital lobe.
Multiple sclerosis, paresis, arteriosclerotic disease, all forms of headache, tuberculous meningitis, chronic hydrocephalus and hysteria are the chief conditions causing difficulty. Multiple sclerosis, if the patches are solely cerebral, may cause confusion, especially in the acute cases, as described by Marburg and others. The bitemporal pallor of the discs in this disorder differs from the usual pressure changes in the disc. Nystagmus is not a fre quent brain-tumor sign. Other signs of pyra midal tract implication may be identical. Head aches are usually absent, also nausea and vomiting. Pseudoparetic and arteriosclerotic psychical syndromes (Korsakow's psychosis) are frequently confused with cerebral tumor, i.e., the cause of the mental picture is over looked. Thus a tumor, which might have been removed, has been missed under the psychotic disguise. Eye-ground changes are usually posi tive in these cases, yet may be absent. Head ache should always be scrutinized carefully. A postinfluenzal occipital headache which is very frequent and extremely severe and persistent is frequently highly suggestive of brain tumor. The headaches from lead poisoning, anaemia and nephritis arc also to be excluded. Brain abscess and tuberculous meningitis must be ex cluded on the ground of their difference in development of symptoms. Symptomatically speaking they may be considered as tumors. This is also true of chronic hydrocephalus. Cerebral puncture, withdrawing a small plug of brain tissue through a trephine opening, and canula is often of great aid in diagnosing very puzzling cases.