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Cerebral Hemorrhage

brain, clot, arachnoid, blood, haemorrhage, found, mater and usually

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Rupture of vessels and effusion of blood into the brain is in the child a comparatively rare accident. In new-born babies, however, extravasation into the arachnoid sac (meningeal haemorrhage) is not uncommon if the labour has been difficult and slow. Indeed, Cruveilhier has stated that amongst still-born children one-third of the deaths may be attributed to this cause. Under three years of age it is rare to meet with any other form of intracranial hemorrhage than that into the arachnoid, or the meshes of the pia mater, although Billiard found a clot in the left corpus striatum in an infant only three days old, and Berard found a similar lesion in a child of eight months. But after the third year a true cerebral haemorrhage is more likely to occur, and sometimes it produces much the same symptoms as are found in the adult to accompany a clot in the brain.

Causation. —When meningeal limmorrhage occurs during birth it is in cases where the head of the fcetus is locked in the brim of the pelvis, and the bones of the skull are forced to overlap from the pressure brought to bear upon them. If it occur after the birth of the child it is usually a secondary affection, and may be induced by any cause which is 'capable of giving rise to severe and long-continued congestion of the brain. Thus it may be found in cases of thrombosis of the cranial sinuses ; it may be induced by tumours of the brain pressing upon the Herophili and the veins of Galen ; it may be a consequence of convulsions or whooping cough, and it is said to be often found in cases of death from infantile tetanus. It appears to be predisposed to by conditions which lead to de bility and cache:via, such as bad feeding and acute exhausting disease.

The same agencies which induce cerebral haemorrhage in infants may cause extravasations of blood into the skull cavity of older children. In these subjects the haemorrhage may take place into the meninges, the ven tricles, or the substance of the brain. In htemorrhagic ffurpura the menin ges of the brain, like other parts of the body, are occasionally the seal of extravasations of blood. In many cases, especially when the effusion occurs between the dura mater and the skull, the haemorrhage may be attributed to a traumatic cause. Children, too, like adults, may die from that com paratively rare accident—rupture of an aneurism on the brain. Cerebral aneurism occurs in early life much more frequently than the ordinary forms of aneurism. Out of seventy-nine cases collected by Dr. Peacock no

less than four were found in children between the ages of thirteen and fif teen years, and a boy, twelve years of age, recently died of this disease in the Victoria Park Hospital, under the care of one of my colleagues. Still, liable as children are to cerebral disease, haemorrhage into or on the brain is not common in young subjects, so far at least as can be judged from the results of post-mortem examinations.

Morbid young subjects ha morrhage is in general capil lary. Rupture occurs in small vessels and the effusion of blood is gradual. In the meninges of the brain the extravasation usually takes place in the arachnoid sac ; but it may be also formed between the dura mater and the bone, in the meshes of the pia mater, and in the lateral ventricles. In the arachnoid sac the blood is either liquid, of the consistence of, syrup, or is separated into a solid and a liquid portion. On opening the the dura mater is of a deep violet colour from the presence of the dark. clot beneath it. On examination this clot is seen to be spread over the surface of the brain. It usually occupies the situation of the posterior lobes and the cerebellum, and may even reach as far as the vertebral canal. It is thickest in the centre unless a part of it covers the fissure between the hemispheres, in which case it is usually thickest at this spot, as it here dips down towards the fornix. Towards the circumference it thins off, and is usually continued for some distance as a false membrane which re sults from absorption of the colouring matter of the effused blood. This false membrane near the clot is readily distinguishable, but it fades grad ually towards the edges and is log on the surface of the arachnoid. The clot generally adheres slightly to the parietal layer of the arachnoid, al though it may be readily separated, and the membrane beneath it has a perfectly normal appearance. The visceral layer of the arachnoid, however, is often thickened and opaque. The clot and resulting false membrane are in rare cases stratified—an appearance probably produced by succes sive additions to the original extravasation. Sometimes we find more than one clot, the effusion having taken place at various points. The thickness may be from a few lines to an inch or more.

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