Cysticerci, the second stage of the tienia solium, when they occur in the brain, are usually numerous. They are generally found in the gray substance or at the surface. They are especially partial to the pia water, and are usually more or less embedded in the gray matter of the convolu tions. They vary in size from a pea upwards. Occasionally they die and become changed into a thick "mortar-like" substance containing booklets.
Hydatids, the second stage of the teenia echinococcus, usually exist, several together, enclosed in an outer sac. The most frequent situation is the centre of the white matter in one of the hemispheres, and the cyst may grow to a large size. The hydatid, although rare at all ages, is not proportionately less common in children than in adults. In twenty-four cases of hydatids of the brain, collected by Dr. Bastian, in which the age was stated, three occurred in children under the age of ten years.
of the brain, if they grow slowly, if they are situated at a distance from the base of the brain and the large ganglia, and if they merely displace the brain filaments without destroying them, may produce absolutely no symptoms at all. This fact, which has been ascribed to a supposed faculty of accommodating itself to pressure residing in the brain, is better explained by Niemeyer to be due to the atrophy of cerebral substance which takes place in the neighbourhood of slowly growing tumours, allowing of increase in size of the growth without interference with cerebral function. Sometimes the symptoms are so trifling as to be overshadowed by others arising from disease or disturbance of a different part of the body. Again, after being a long time latent, the growth may give rise to obstinate headache, to a slight squint, or some other form of muscular spasm ; and for weeks or months this may be the only symptom to be detected. In cases where the morbid growth consists of cheesy matter other symptoms may arise not due directly to the cerebral tumour. Thus the patient often dies of a tubercular meningitis, the symptoms of which may quite conceal any special phenomena resulting from the tumour of the brain.
• There are no symptoms peculiar to an intracranial growth, for all are the consequence of local destruction of substance, of pressure on the tissue around, and of interference with its vascular supply. A distinctive char acter is, however, given to the disease by its course, the sequence of its phenomena, and the predominance of some symptoms over others.
There are certain general symptoms which are found in most cases of cerebral tumour. Headache is usually early to occur, and may remain for a long time the sole morbid phenomenon. Often slight at first, it becomes
gradually more intense, and may assume a violent paroxysmal character which is infinitely distressing. Infants show this by contracting the brows, throwing up the hand to the head, rolling the head from side to side, and occasionally breaking out into piercing cries. An older child will place his hand upon the site of the pain if asked to do so. He avoids the light ; shudders at a loud noise ; and often buries his face in the pillow of his bed, or covers his head with the bedclothes. The attacks of headache are generally accompanied by vomiting, and often by dizziness.
Sooner or later convulsions, tonic or clonic, may supervene. These are sometimes complete and bilateral, and resemble attacks of epilepsy. Sometimes they are partial, and are confined to the face, the eyes, or one limb. The convulsions may be preceded by tremours or twitchings without loss of consciousness, and it may happen that these latter are present with out being followed by more decided seizures. If attacks of such motor disturbance, of whatever degree, are noticed from time to time in the same part, or persist in it, the symptom is a very suspicious one. Convulsions are said to be more common when the growth is situated in the posterior lobes of the brain, and to be less frequent when the anterior lobes are affected. If the seizures are epileptiform in character, the tumour is proba bly in or near the cortical substance of the cerebrum.
The convulsions may be followed by temporary paralysis in the affected muscles, and in some cases a permanent paralysis may be observed. This more commonly affects muscles supplied by cerebral nerves than is the case in other diseases of the brain. The external rectus may be affected (sixth nerve), producing convergent squint ; there may be ptosis, dilatation of pupil, and external strabismus from paralysis of the third nerve ; the facial muscles may be paralysed ; and there may be impairment of deglu tition or articulation. Sometimes hemiplegia is produced. The cerebral nerves are affected on the same side as the growth : the spinal nerves on the opposite side. If, however, there be several tumours present in the brain, nerves of both sides may be involved, and we may find hemiplegia combined with variously distributed paralyses on both sides of the face. Generally the paralysis is developed slowly, and is preceded by pain in the muscles about to be affected. When it occurs suddenly after a convulsive seizure, the case is often mistaken for one of cerebral lnemorrhage. Con tractions often occur in the paralysed muscles, and may follow the paralysis very rapidly.