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Apoplexy Brain

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BRAIN, APOPLEXY OF.—A suddenly occurring, and usually extensive, one-sided paralysis, due to the obstruction or rupture of a blood-vessel of the brain.

Obstruction of a blood-vessel is brought about either by coagulation of the blood in an artery of the brain, or by the lodging of blood-clots, formed in one of the large arteries of the body, and carried into the blood-vessels of the brain by the blood-current. The results are the same in either instance : occlusion of the blood-vessel, obstruction to the circulation of the blood, and disturbance of nutrition in the form of a softening of the brain-substance. It is only occasionally that the occlusion is brought about by the morbidly thickened wall of a blood-vessel, which little by little narrows the blood channel and interferes with the circulation ; this is the case, for instance, in syphilis of the brain. Not infrequently the formation of thrombi is brought about by septic infections, such as typhoid fever or pneumonia, and particularly by acute articular rheumatism.

The rupture of a blood-vessel, with subsequent flow of blood into the brain, is always the result of a vascular affection, which is characterised by calcification and brittleness of the wall of the blood-vessel. This calcifica tion of veins and arteries occurs especially in an advanced age ; it is furthered by the abuse of alcohol. The immediate cause of an apoplectic stroke is usually a rush of blood to the head, such as occurs after mental emotions, or after an abundant meal or a drinking-bout. So-called " apoplectic " indi viduals—that is, broad-shouldered, corpulent persons, with short necks and flushed faces, who are fond of alcoholic drinks, and who often suffer from disturbances of heart and respiration as indicative of an existing disease of the blood-vessels—are more prone to hemorrhages of the brain.

The symptoms of apoplexy due to obstruction of the blood-vessels do not differ much from those of apoplexy due to hemorrhage, except in that the latter are generally more severe. An attack is frequently preceded for days, weeks, and occasionally for months by cautioning " forerunners " in the form of headache, dizziness, ringing of the ears, rapidly passing disturb ances of speech, and attacks of fainting. The attack proper sets in slowly, or rapidly and violently, according to whether the occlusion of the vessel, or the haemorrhage, took place gradually or suddenly. In the former case the patient becomes mentally uncertain, dull, confused, and staggering ; he loses the use of his arms and legs, and finally complete loss of consciousness takes place, accompanied with usually a one-sided paralysis. In an acute attack, such as usually occurs after severe hemorrhages, the patient falls to the ground as if struck clown, and loses consciousness at once. His face is generally (but not always) flushed, his respiration snoring, and his lips and cheeks drawn in and puffed during breathing ; his limbs are without motion, and when raised they fall back, completely relaxed ; urine and feces are discharged involuntarily. In case the hemorrhage is very profuse and affects a vital part of the brain, death occurs, sometimes at once, sometimes after a few hours or days, without the patient recovering consciousness.

More frequently, however, the patients recover from such attacks. The blood extravasated into the brain is in part absorbed by the lymph-vessels ; in part it breaks down or is encapsulated ; or it leaves a scar. Conscious ness returns gradually, but a one-sided paralysis remains as a result of the destruction wrought in the brain. According to the extent of the damage to the brain-tissue, these paralyses affect larger or smaller parts of the body. They may remain permanently, or they may pass entirely or in part. In contrast to paralysis of the spinal cord, brain-paralysis involves only one side of the body, and always the side which is opposite the site of the haemor rhage or occlusion ; hence a haemorrhage into the right side of the brain causes a left-sided paralysis, and vice versa. In severe cases the paralysis may extend over an entire side of the body, involving one-half of the face, one arm, and one leg. Right-sided paralysis (resulting front left sided hemorrhage) is usually associated with a material disturbance of speech.

In case the apoplectic attack runs a favourable course, the patients are able after a few weeks again to move their limbs, although only imperfectly at first ; speech also returns. The degree of improvement which may take place in the course of months and years depends entirely upon the severity of the lesion, and in part also upon the correct treatment. In very favourable cases all symptoms recede, whereas in severer ones some muscles remain permanently paralysed or at least impaired in function. The paralysed limbs, especially the arm and the hand, become affected by as well as by trembling or by movements resembling St. Vitus's dance. The mental capacity of the paralysed persons is frequently affected as well. They may lose their memory, or they may become dull and indifferent ; and t hey have no conception of the severity of their malady. It is never possible to make a reliable prediction as to the result, the less so as these attacks frequently recur. Slight hemorrhages (or occlusions of vessels) cause only insignificant disturbances of consciousness, dizziness, ringing of the ears, and temporary weakness in arms and legs.

The best treatment for apoplexy of the brain is the preventive treatment. Persons suffering from heart-disease and old people with changes of the blood-vessels and with apoplectic predispositions should avoid all causes Ivhich might result in a congestion of blood to the head. They should lead temperate lives, abstain entirely from alcoholic drinks, and beware of over exertions of any kind. Very little can be done for the treatment of the apop!ectic stroke itself. The patient should be put in bed, with the upper part of the body raised if the face is flushed, and with cold compresses to the head. It may he of service also to place the feet in hot water. The further treatment, especially that of the consequent conditions, must be left to the physician. Alcoholic drinks should be avoided.