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Diseases of the Nervous System the

symptoms, lesion, disease, child, cerebral and movements

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THE diseases of the Nervous System in childhood present many difficulties. In early life the excitability of the reflex centres is normally in excess ; and can even be heightened by causes which rapidly modify the general nutri tion of the body. Consequently slight irritants may give rise to symptoms of tumult in the nervous system which are out of all proportion to the ap parently trifling character of the lesion which has produced them. On account of this excessive irritability of the nervous system many patho logical states in the child express themselves by convulsive movements which in the adult are accompanied by much less striking symptoms. In the young subject signs of nervous disturbance may arise quite indepen dently of actual disease in the nervous centres ; and the apparent violence of the commotion is not- influenced by the seat of the irritant, and bears no proportion to the severity of the lesion of which it is the expression. Indeed, the same violent spasmodic movements may be the consequence of lesions so various in situation and in gravity, that in a case where such symptoms are noticed it is often by no means easy to discover the position of the irritant or to say at first whether or not the nervous centres are free from disease.

• In cjaildren investigation of disease of the cerebro-spinal system is car ried on by means exactly the same as are employed in the case of the adult. As, however, the young child cannot describe his sensations we have to trust much to objective symptoms, and are dependent upon the memory and observation of others for important information as to peculiarities of manner and changes in temper and disposition.

Of the symptoms to which cerebral disease gives rise some are peculiar to a centric lesion, while others are present in every case of nervous dis turbance, however it may have originated. In every variety of acute ill ness in the young child the impressionable nervous system shows signs of distress. This is well seen in a case of acute indigestion.. The skin be comes burning hot ; the child is restless, cries and talks wildly ; he twitches and starts in his uneasy sleep and, if an infant, may be violently convulsed. These symptoms indicate nervous disturbance but are not dis

tinctive of cerebral lesion. So, again, a child may scream out with pain, and frequently carry his hand to his forehead or ear, without his headache being necessarily a sign of disease of the brain.

There are other symptoms which are more directly indicative of cerebral origin ; but which may still be present without owing their rise to any discoverable lesion of the nervous centres. Thus, squinting is a sign which should always be viewed with great suspicion. It is frequently present in convulsions, whatever their cause, and may even continue after the nervous seizure is at an end without being necessarily a sign of any thing more serious than derangement of function. Sometimes the defect becomes a permanent one, and yet after death from some accidental cause a post-mortem examination of the body discovers no lesion within the skull. Strabismus is not therefore necessarily a grave symptom. Still, it is so frequently a consequence of serious disease of the brain and membranes that its persistence after a convulsive attack should always give rise to un easiness. An external squint, when it occurs without having been pre ceded by spasmodic movements, is often a sign of pressure upon the cor responding crus cerebri, and may be an early symptom of cerebral tumour. Strabismus may, however, occur as a consequence of hypermetropia ; and an intermittent squint is not unfrequently a symptom of chronic digestive derangement. Therefore, in all cases, careful search should be made for further evidence. In the case of cerebral tumour external squint is usually associated with ptosis and dilated pupils ; headache and vomiting will probably have been complained of ; there may be tremors or spasmodic movements in other muscles ; the sight is often impaired, and an moscopic examination may reveal the presence of optic neuritis.

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