Cerebral Hemorrhage

child, left, symptoms, clot, convulsions, temperature and hospital

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Often the cerebral haemorrhage is only one of several lesions occupying the cranial cavity. It is then difficult to assign to each its clue share in the production of the symptoms.

A little girl, aged fifteen months, with ten teeth, was brought to the hospital on July 13th. According to the mother's account the child, although hand-fed, had walked at the age of ten months, and had always been regarded as healthy until the previous March, when she had had a fall down a flight of stairs. The child was not stunned by the accident, but vomited and "was ill" for a few days. She then began to lose flesh and ceased to run about, always crying to be nursed. On June 4th, she had a violent convulsive seizure which began with hiccough. The spasms were limited to the left side, and lasted nine hours. When they ceased the left arm and leg were noticed to be powerless, and the face was drawn to the right side.. The paralysis passed off in about a fortnight, but the child remained weakly. She began•to have a discharge from the left ear and the nostrils. She seemed to suffer much from pain in the head ; often vomited; and the bowels were somewhat loose. On two occasions she had general convulsions of an hour's duration. She took liquid food well.

Towards the end of June the child became much worse. She began to cough ; her breathing was rapid ; she sighed a great deal; seemed very drowsy, and at times would scream out suddenly as if in pain.

On admission into the hospital (on July 13th) the temperature was 101° ; pulse, 160 ; respirations, 88. The patient was fretful and screamed almost incessantly until 11 P.M., when she had an attack of general convul sions. At this time her temperature was 104°. On the following morning she was found very pale ; the fontanelle was depressed ; the eyes were turned constantly to the right ; the pupils were unequal and insensible to light, the left being the larger of the two. Both arms were convulsed, and the right leg and left hand were rigid ; there was no paralysis of the face. The hands, feet, and nose felt cold, although the temperature in the rectum was 102.4°. The pulse was very small, 170. The abdomen was soft and not retracted. Pressure on the skin produced little flush. On examina tion of the back dulness was noted on both sides with abundant crepitat ing rules. After this the child remained insensible and died at 6 P.m.

On examination. of the body much yellow lymph was found covering the right middle lobe of the cerebrum. There was an old clot, the size of a hen's egg, occupying the right corpus striatum and the superjacent part of the right hemisphere. Scattered caseous nodules, the size of a large pea, were seen in the right hemisphere, and the choroid plexus ; and some gray granulations were discovered on the vertex of the brain along the course of the vessels, and a larger number at the base. The lungs were the seat of catarrhal pneumonia. The liver, spleen, and kidneys contained small yellow nodules ; and the bronchial and mesenteric glands were enlarged and caseous.

In this case there can be little doubt that the convulsions and hemi plegia noted on June 4th resulted from the apoplectic clot. The after symptoms were, no doubt, the consequence of the meningitis and general tuberculosis. The case is interesting as showing that a copious extravasa tion is not necessarily fatal ; for it is reasonable to suppose that had the clot been the sole lesion present the child would not have died.

Cerebral hemorrhage in the child is not, however, always accompanied by symptoms so characteristic. Violent convulsions and sudden death may be produced by a clot in the substance of the brain ; or a child may be seized with repeated ; may then be taken with convulsions ; and afterwards fall into a state of unconsciousness with dilated pupils, rapid feeble pulse, and cool skin, and die in the course of a few hours. These were the symptoms noticed in the case of a boy who died in the Victoria Park Hospital from rupture of a cerebral aneurism. The notes of the case were kindly furnished to me by Dr. Humphry, the resident physician.

A scrofulous-looking boy, aged twelve years, was admitted into the hos pital under the care of my colleague, Dr. Birkett, on March 15th. He had had scarlatina four years before, followed by dropsy, and there was besides a doubtful history of rheumatic fever at about the same time. For two years the patient had complained of shortness of breath, which had lately been getting more distressing. When admitted, a loud mitral murmur was detected, with considerable hypertrophy of the heart.

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