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Cerebral Tumour

brain, usually, matter, size, growth, mass and cheesy

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like adults, are subject to morbid formations in the brain which may give rise to a variety of symptoms according to the situation of the growth. In the case of a child, however, "tumour " of the brain usually means "tubercle " of the brain, for it is only in exceptional cases that any other form of cerebral growth is to be found. Still, in rare in stances cancerous, glyomatous, and syphilitic nodules are developed in this region, and occasionally we meet with the cysticercus cellulosa or the hyclaticl cyst.

Morbid Anatomy.—Tubercle of the brain is said to be rare under the age of two years ; but I think the occurrence of the disease in infants is more common than has been supposed. It is seldom seen in the cranium without other organs being similarly affected, although in exceptional cases it may be a solitary instance of tubercular formation in the body. The seat is most frequently in the cerebellum, but it is also common in the hemispheres of the brain. Next in order of frequency, according to Andral, come the pops, the medulla oblongata, the peduncles of the cerebrum and cerebellum, the optic thalamus, and the corpus striatum. In number there may be one or more, and in size they may be small or large. Usually the more numerous masses are of small dimensions. Single tumours may be as small as a pea or as big as an egg, or even of still larger size ; but they are most commonly met with about equal in volume to a filbert or small marble. The masses are almost always sur rounded by a fibrous covering which separates them from the brain-sub stance around. In exceptional cases, however, i.e., where death has taken place while the tumour is still growino. the limits of the mass are not thus circumscribed, but its substance passes insensibly into the adjacent cerebral tissue. When the tumour ceases to extend itself, an areola of connective tissue and vessels forms at its circumference, and develops into a fibrous envelope which varies in thickness according to the age of the growth.

On section the tumours are yellowish white, or have a faint greenish tint, and are found to consist of cheesy matter. Their consistence is more or less firm, but the centre is usually softer than the circumference, and may be converted entirely into a creamy pulp so as to give the appear ance, with the firm envelope, of a little bag of pus. Tuberculous matter

found in the brain is seldom seen in any other shape than that of yellow caseous matter. Lebert and Rokitansky, however, agree that in excep tional cases it may begin as the gray granulation ; but it seldom remains long in this stage and very quickly becomes cheesy and yellow. Around the mass the brain-substance may be natural, or congested, or more or softened by cedeina. Often the collections of tubercle spring from the pia water, and are attached to it by a fibrous stalk continuous with the envelope, and filled like it with tuberculous or cheesy matter. Tuber culous meningitis is often present, and is the direct cause of death. If the mass be on the surface of the cerebellum, and so placed as to press on the straight sinus or the versa magna Galeni, it may be a cause of chronic hydrocephalus. It is not often that a cretaceous change takes place in cheesy matter situated in or upon the brain, for the irritation set up is usually so injurious that death takes place before this transformation has had time to occur. Still, it is sometimes met with.

Cancer of the brain is rare. When it occurs it is usually secondary to a similar growth in the eye ; or, as recorded by Steiner, may advance in wards from the skull. When thus secondary, it may appear in several centres. The size of the mass varies from a pea to an orange. These so called cancerous growths have usually the characters of sarcoma.

Gliomatous tumours of the brain are solitary growths which increase slowly in size, so that they may be long in producing appreciable effects. They often reach considerable dimensions, and occupy by preference one or other of the posterior .cerebral lobes. Their borders are not well defined, and their substance passes gradually into the brain-tissue around. Their consistence is usually firm, and they are rather more vascular than the cerebral substance in which they are embedded.

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