Showing papers in "Journal of Nervous and Mental Disease in 1928"

Cerebral circulation: iii. the vasomotor control of cerebral vessels

Abstract: It is a common opinion among physiologists that the cerebral blood vessels do not possess effective vasomotor nerve control. The strongest evidence on which this opinion rests has been brought forward by a number of English physiologists, notably Roy and Sherrington,1Bayliss and Leonard Hill,2Hill and Macleod3and Florey.4Several Germans5have also contributed evidence pointing toward the same conclusion. On the other hand, many important observations which are difficult to reconcile with this point of view have been reported by investigators from Germany,6from France,7from the United States,8and elsewhere.9Our own experiments bring new evidence in favor of the functional activity of vasomotor fibers in the blood vessels of the pia mater. The question whether or not the cerebral vessels possess a vasomotor control is not merely of academic interest, for many clinical conditions such as convulsions

The cerebral circulation: i. observation and measurement of pial vessels

Abstract: The purpose of this paper is to describe a new technic for observing and measuring the changing diameters of the blood vessels of the piaarachnoid, together with fluctuations in intracranial and intravascular pressures. Of the many ways devised in the past for studying the factors which operate to control the blood supply of the brain, two general procedures have been found most useful. First, the recording of pressures within the skull and within arteries and veins in divers situations and under varying experimental conditions, and second, the direct observation of blood vessels on the surface of the brain through an opening in the skull. Each method has its advantages and its limitations. Up to the present time, the method of measurement and comparison of pressures has yielded more important data than that of direct observation. The technic of the latter, however, has never been perfected, nor have its possibilities been

Compression of the spinal cord due to ventral extradural cervical chondromas: diagnosis and surgical treatment

Abstract: Within the past few years an unusual group of tumors of the spinal cord, not heretofore recognized as a definite clinical entity, has come under observation. They are discrete, sharply circumscribed, ventral, extradural chondromas lying in the midline or slightly to one side of the midline, usually in the region of the fourth, fifth or sixth cervical vertebrae. The more typical of these tumors present sufficiently defined clinical signs to permit recognition before operation. The most characteristic picture is that of marked unilateral spasticity, with atrophy and weakness of the muscles of one or two cervical segments at the level of the tumor and on the side of the spasticity, and changes in pain and temperature sense on the opposite side. Muscle, joint, vibratory and discriminative sensations are unaltered. The upper limit of the sensory changes is usually several segments lower than the atrophy and motor weakness, which, as has

Encephalitis periaxialis concentrica

Abstract: The heredofamilial or endogenous diseases of the central nervous system are characterized by germ layer selectivity, system selectivity and segment selectivity (Schaffer). 1 The exogenous diseases of the brain and spinal cord, the etiology of which is unknown or which belong definitely to the group of infectious maladies, are localized in a characteristic way in the gray or white matter of the central nervous system. Both the gray and the white substance of either the brain or the spinal cord may be selectively the seat of pathologic alterations. Undoubtedly, local anatomic, physiologic and biologic factors play an important part in such selectivity. The nature of these local physiologic and biologic properties of the brain or the spinal cord is unknown. In regard to anatomic structure, it is known that the gray matter is more richly supplied with capillaries than the white substance, and this may result in physicochemical differences. In

A rapid method for staining myelin sheaths

Abstract: The disadvantage of the present methods for the staining of myelin sheaths—Weigert, Spielmeyer, Loyez, Frankel and others—is that they require days or even weeks for the preparation of the material. The following method can be performed within one hour and can be applied to sections fixed in formaldehyde and frozen or embedded in either celloidin or paraffin. Celloidin sections may be stained without removing the embedding material. In paraffin sections, the paraffin should be removed before staining. Frozen sections should be brought into 70 per cent alcohol for from five to ten minutes and then put back into water. Sections should be from 20 to 30 microns thick. The agents used are: (1) 5 per cent water solution of potassium dichromate; (2) 4 per cent water solution of iron alum; (3) 1 per cent water solution of hematoxylin prepared from 10 per cent absolute alcoholic solution (at least 6

THE CEREBRAL CIRCULATION: v. OBSERVATIONS OF THE PIAL CIRCULATION DURING CHANGES IN INTRACRANIAL PRESSURE

Abstract: Investigation of the cerebral circulation during periods of increased intracranial pressure was given renewed impetus by Cushing.1He demonstrated the existence of a hindbrain regulatory mechanism and showed that partial anemia of the vasomotor center might bring about a rise in systemic blood pressure great enough to maintain cerebral circulation during excessive elevations of intracranial pressure. In addition to his manometric studies, Cushing made observations of the pial vessels through a window placed in a trephine-sawed hole in the skull in dogs. During the period of increased pressure within the skull, he noted collapse of the sagittal sinus, distention and stasis in the tributary veins, and obliteration of the arteries and arterioles, with blanching of the cortex. Making use of a recently developed technic we have reinvestigated the effect on the pial blood vessels of large rises in intracranial pressure. Our object has been to learn by actual measurements

Effect of age on vibratory sensibility

Abstract: CONTENTS Review of the Literature Author's Experiments Varieties of Patients Studied Technic of Examination Results Transmission of Vibratory Sensibility and Cause of Its Loss Nature and Path of Transmission of Vibratory Sensibility Location of the Pathologic Lesion Vascular Supply of the Spinal Cord Spinal Arteriosclerosis the Probable Cause of Vibratory Loss Summary and Conclusions The results of this study—diminution or loss of the sensation in the lower extremities of a large percentage of persons in the involutional period of life—are deemed worthy of record, because it is during this period that changes in vibratory sensibility assume considerable importance for diagnosis; if such an alteration is found in normal persons, it indicates the need for wariness in arriving at a diagnosis based on alterations in this form of sensation. REVIEW OF THE LITERATURE In a review of the literature, no study of a large number of persons from this standpoint was

Progressive degenerative subcortical encephalopathy: (schilder's disease)

Abstract: In 1922, we presented before the American Neurological Association1the clinical and pathologic observations in a case which we termed progressive subcortical encephalopathy. Clinically, the case (that of a child) was characterized by an acute onset and progressive development of generalized spasticity and mental deterioration, followed by convulsive attacks and other features of a decerebrate rigidity as terminal events. The anatomic alterations were striking. They were degenerative and, although diffuse and widely distributed, were nevertheless distinctly limited to the white substance (subcortex) of the cerebral and cerebellar hemispheres. The gray matter was undisturbed and was without the slightest suggestion of disease. Since that time, three more cases of similar character have come under observation. They are all so strikingly alike anatomically and have so much in common clinically that we are presenting them as members of a single group. In describing these cases, it is our aim to find

Punctures of the brain: the factors concerned in gliosis and in cicatricial contraction

Abstract: In a series of experimental punctures of the brain performed by one of us, 1 it was observed that, in addition to the usual scar composed of connective tissue and neuroglia, open tracks which did not contain any connective tissue and which were surrounded by little if any gliosis occasionally resulted. In the hope of explaining these variations, we have compared the result obtained from leaving injured brain tissue in place with the result following removal of an equal portion of such tissue. The investigation has thrown light on certain factors controlling gliosis and points to a fundamental principle involved in surgery of the brain. LITERATURE In general, the literature shows that wounds produced in experimental puncture of the brain have frequently been made by heated blunt needles (Tschistowitsch, 2 Coen, 3 Macklin and Macklin 4 and others). This produces a wide zone of injured tissue. The conclusions reached by

The schizophrenic syndrome as a product of acute infectious disease

Abstract: May schizophrenia result from acute infectious disease; if so, in what manner and with what frequency does this occur, and what is the relation of this psychotic product to the so-called symptomatic psychoses? To these problems the present study is addressed. No one now doubts the exogenous origin of some cases of the schizophrenic syndrome, cases of what are in every other respect orthodox "dementia praecox"; Bleuler, Jaspers, Kretschmer, Birnbaum and others have advanced this fact beyond dispute. Few writers, however, have been statistically precise. To these, Rosanoff1and Strecker2are exceptions; the former found somatic exciting causes in twenty-six of 202 cases of schizophrenia, and the latter found that in seventeen of 100 cases there were serious or overwhelming physical disease as precipitants and in seventeen others there were somatic precipitants of doubtful (not insignificant) importance. There is scarcely any literature regarding the percentage of schizophrenic patients

The mammalian cerebellum: a comparative study of the arbor vitae and folial pattern

Abstract: This study represents a survey of the class of the mammalia from the. point of view of the form of the arbor vitae and the folial pattern of the cerebellum. On account of certain deficiencies in the study collection, it is not yet complete. A number of the orders, such as the monotremes and the insectivores, are unrepresented by examples, and this is increasingly true in connection with many of the suborders, families, subfamilies and species which make up the class of the mammalia. As these forms become available they will be studied and will form the substance of a further communication on this subject. In order that definite conclusions may be reached in regard to functional localization within the cerebellum on the basis of the characteristics of the folial pattern as compared with the physical organization of the animal providing the pattern, a much greater number of cerebella must

The brain in mongolian idiocy: a report of ten cases

Abstract: Mongolism, like acromegaly, exophthalmic goiter, cretinism and many other diseases deeply affecting the personality of its victims, may be diagnosed clinically at a glance. This fact gave rise to its quick recognition throughout the world after the name was coined by Langdon-Down 1 in 1866, and the literature became flooded with case reports and general articles on the subject. These, however, dealt with it largely from the clinical, statistical, sociologic and etiologic points of view. The pathologic anatomy has received much less attention. This is especially true of the finer histology of the nervous system, and individual studies directed toward this point have usually been made on relatively few cases; moreover, the observations of various authors have often been contradictory. The present report is based on a study of the brains from ten patients with mongolism found in the collection of the Staatskrankenanstalt-Friedrichsberg in Hamburg, and has been made possible

Pineal pathology: further studies

Abstract: The function of the pineal body in the human organism is still a subject of controversy. By some it is considered to be a gland of internal secretion; by others, a vestige of the median eye of certain reptilian forms. No one believes now in the suggestion of Descartes that it might be the seat of the soul, but numerous phylogenetic, embryologic, histologic and clinicopathologic studies, as well as experiments in feeding and extirpation, have not succeeded in establishing definitely its function. Tilney and Warren1believe that they have demonstrated a glandular structure in the pineal body of the human embryo, and von Volkmann2thinks that he has found secretory granules in the pineal cells. On the other hand, Hortega3cannot find evidence of secretory activity in either the neuroglia or pineal parenchyma, and he believes that the granules found by von Volkmann are blepharoplasten akin to

Cerebellar tumors occurring in identical twins

Abstract: This presentation is of interest because of the occurrence of cerebellar tumors in twins that were apparently of the monozygotic or identical type. The illustrations are those of tissue from the first twin who died. It was impossible to obtain the consent of the parents for the necropsy on the second twin. However, there is little doubt that the diagnosis of the lesion in the second twin was cerebellar tumor. The exact location and histopathologic type of this tumor is, of course, not known. The first twin died in December, 1924, at the age of 61/2 years. The second died in March, 1927, when 81/2 years of age. At the time of the death of the first twin the second had not shown any symptoms of the illness; because of this, it was impossible to obtain measurements of the twin, particularly the patterns of their palms and soles. My reason

The electrical skin resistance: diurnal and daily variations in psychopathic and in normal persons

Abstract: Several years ago, in an endeavor to study experimentally the emotional reactivity of various psychopathic personalities, an investigation was made of the psychogalvanic reflex. In attempts to standardize the records so that the responses would be strictly comparable, however, great individual variations were encountered in the resistance offered by the body to the passage of a constant galvanic current. In order that this suggestion might be followed further, therefore, the electrical resistance was measured in each person to whom the psychogalvanic association test was given. When it was found that these incidental readings of resistance seemed to vary to a greater degree with different types of mental illness than did the psychogalvanic response, a detailed investigation of the electrical resistance of the human body was undertaken 1 in the hope that the significance of the more basic phenomenon of the resistance variations might be determined. In preliminary records, the lowest

The development of human motility and motor disturbances

Abstract: The motility of higher mammals can be divided into two large groups of different movements. One of them is cortical in origin and deals with the finer adjustment of isolated movements to visual, acoustic and tactile stimuli. The efferent impulses for these movements leave the brain largely from the area gigantopyramidalis. The other group, called principal motility by von Monakow, consists of coarse responses to sensory stimuli, namely, all those innervations which are necessary for standing and locomotion and for the motor part of alimentation. The investigations of Freusberg,1Sherrington,2and Magnus3have shown that even the isolated spinal cord gives certain rather complicated responses to pain and to cutaneous and proprioceptive stimuli. If not only the spinal cord but also the centers of the lower part of the brain stem are left intact, then a general integration of tonic innervations for the whole body appears, which

Acute pathologic changes in neuroglia and in microglia

Abstract: Understanding of the acute changes which the interstitial cells of the central nervous system undergo has increased step by step with the improvement and simplification of cytologic methods. The newer impregnation methods of Cajal 1 and Rio-Hortega 2 serve to demonstrate the pathologic alterations in the supporting cells as clearly as they show their normal histologic detail and to demonstrate them in the same selective manner. With these specific methods the acute changes which the various cell groups undergo can be followed clearly. Many questions which had to be left unanswered because of inadequate staining methods can be settled. Much of the work on the acute changes in the interstitial cells by the Spanish school of neurology has been done with the use of experimental material from animals. It has seemed worth while to present the acute changes as they are seen in material from human beings 3 and to

Optic nystagmus: technical introduction, with observations in a case with central scotoma in the right eye and external rectus palsy in the left eye

Abstract: Although the ocular nystagmus resulting from watching moving objects has been recognized for many years, it has not received the scientific attention comparable to the intensive investigation, both clinical and experimental, that has been accorded the nystagmus evoked by labyrinthine stimulation. Dodge1described photographic records of the eye movements evoked by a group of moving objects in 1903, and by a moving pendulum2in 1907. The latter type of visual stimulus was subsequently utilized by Diefendorf and Dodge3in the study of the ocular reactions of patients with mental disease. Barany4was the first to study the nystagmus elicited by a succession of moving objects in connection with ocular palsies, soon followed by the work of Wirths.5Coppez6briefly described this type of eye movement in 1913, and in 1920, Bartels7found that it occurred in reptiles and birds but stated that optical

Acute toxic encephalitis in childhood: a clinicopathologic study of thirteen cases

Abstract: Nonsuppurative encephalitis includes all inflammations of the brain not characterized by the formation of an abscess and therefore a number of unrelated diseases: polio-encephalitis, epidemic encephalitis, encephalitis secondary to a contiguous meningitis and a vague, indefinite condition called toxic encephalitis. The first three types have been carefully studied clinically; they reveal specific pathologic changes and are probably due to invasion of the brain substance by a specific virus even though it has not yet been demonstrated. Little is found in the literature to prove that toxic encephalitis is anything but a clinical designation. According to some textbooks, however, such an involvement of the brain is not uncommon. Dana,1for example, speaks of a secondary or toxic encephalitis and of an encephalitis due to influenza, by which he does not mean the epidemic type. In 1884, Strumpell2and later Leichtenstern described an encephalitis characterized, aside from the acute general

Atypical neuralgia, so called: a critical

Abstract: In the Neurosurgical Clinic of the University Hospital my co-workers and I have had an unusual opportunity for the investigation and treatment of major trigeminal neuralgia, having on our records some 1,200 odd cases. This wealth of material has afforded us an intimate knowledge of the characteristic features of the disease, as well as of the many variations from the normal chain of symptoms. Aside from the cases of true trigeminal neuralgia, we have, in addition, records of 245 examples of what, for want of a better term, we have called atypical neuralgias. As a class, the victims of these irregular or atypical types of neuralgia are a pathetic lot. They often date their discomforts back many years, and they insist that the pain is unbearable and difficult of description; yet they seldom show any evidence of the intense suffering of which they complain. We have been absolutely nonplussed in

Circumscribed suppurative (nontuberculous) peripachymeningitis: histopathologic study of a case

Abstract: The term "peripachymeningitis" was given by Traube1to a combined inflammation of the spinal meninges (dura and pia-arachnoid) and the epidural connective tissue situated between the dura and the periosteum of the vertebrae. Albers2termed this condition perimeningitis; Braun3called it epimeningitis; others called it pachymeningitis spinalis externa. As the foregoing terms imply an inflammation only of the epidural or epimeningeal tissues, it would be proper to reserve Traube's term peripachymeningitis for cases in which a perimeningitis is associated with a pachymeningitis and leptomeningitis. In either condition the main pathologic changes are in the perimeningeal tissues which, as first pointed out by Vulpian,4may be either infiltrated with pus or transformed into "sclerotic tissue." This is sometimes so abundant that it may resemble a veritable new growth. It is thus a purely local process involving only a circumscribed area in the epidural space. As a rule

Local tetanus: a study of muscle tonus and contracture

Abstract: When tetanus toxin is injected into laboratory animals, such as the cat, guinea-pig or rat, the muscles near the site of the injection are the first affected; and if the dose is not too great, the tetanic contractions may remain entirely confined to the limb which receives the toxin. Cats are resistant and develop general tetanus less readily than the rat or guinea-pig and are for this reason especially suited for the study of local tetanus. Doses up to 1 cc. per kilogram of body weight produce only a local effect in the cat, although 0.004 cc. per kilogram of the same toxin will produce a generalized tetanus in the guinea-pig. For this reason, it is much easier to obtain advanced stages of tetanus contracture in the cat. It is well known that tetanus toxin acts on the central nervous system because section of the motor nerve prevents the development

Cerebellar symptoms produced by supratentorial tumors: a further report

Abstract: That the accurate localization of tumors of the brain is often a matter of extreme difficulty is well recognized. False localizing signs, particularly in relation to cranial nerve palsies, have been the subject of a number of communications, but it has rarely been emphasized with what frequency a mass lesion in one area may give definite symptoms of a lesion elsewhere in the brain. Apparently, statistics covering a large number of cases, which have betrayed how often a mistaken localization between a supratentorial and a subtentorial lesion has led to a cerebellar exploration when the neoplasm actually lay in the cerebral hemispheres. have not been compiled from any clinic. An opportunity to assemble a group of cases in which this error in localization was made has been afforded by a recent study by Lehmann 1 of the results of cerebellar operations in Dr. Cushing's clinic. In the course of this

Studies in epilepsy: viii. the clinical effect of fasting

Abstract: The most interesting recent development in the treatment of patients with epilepsy has been the apparent beneficial effect of measures associated with ketosis, viz., fasting and a high fat—low carbohydrate diet. During the past six years, we have been making observations on this subject with two points in mind: (1) to observe the clinical effect of fasting on seizures, and (2) to study the changes which take place in body metabolism that might explain the therapeutic results obtained. With reference to the latter consideration, certain changes in blood chemistry and metabolism which we believe to be without significance for epilepsy have been published. 1 Our observations concerning the changes which are of apparent effect, in both fasting and fat diet and in other procedures designed to influence the frequency of seizures, have been summarized in a recent publication 2 and will be presented in detail elsewhere. 8 Our object in

The cerebral circulation: iv. the action of hypertonic solutions part i

Abstract: Intracranial pressure may be strikingly changed by varying the osmotic pressure of the blood. The intravenous or intraperitoneal injection of hypertonic dextrose, urea or sodium chloride1may lower the intracranial pressure from normal to levels well below atmospheric pressure.2In this paper we have studied the effects of such hypertonic solutions upon the diameter of the pial arteries and veins during the typical intracranial pressure response. In each of the six animals examined very definite constriction of these vessels occurred at the height of the response. Many organs contribute in the transfer of fluids from the tissues into the blood after the injection of hypertonic solution, although some contribute more than others. It is known that the brain and cerebrospinal fluid are greatly reduced in volume.3Moreover, associated with shrinkage of the tissue, there may be alteration in function, especially in smooth muscle. Hughson and Scarff4

The rôle of the dorsal roots in muscle tonus

Abstract: Tonus is the steady and indefatigable contraction of the muscles required to hold the different parts of the skeleton in their proper relations in the various and constantly changing attitudes and postures of the body. It has been defined by Sherrington 1 as postural contraction. A muscle, when functioning for the maintenance of posture, tends to take and hold a given length; and when that length is altered, either by active contraction or by the passive movement of the limb, the muscle again takes and holds the new length. This is particularly evident in decerebrate rigidity. The "lengthening and shortening reactions," so well seen in decerebrate cats, have been described in numerous papers by Sherrington 2 and Brown. 3 These reactions make the limbs of decerebrate animals moldable, so that they will take and hold any degree of flexion or extension passively imposed on them. To use Sherrington's term, the

The ammoniacal silver solutions used in neuropathology: their staining properties, chemistry and methods of preparation

Abstract: The methods of staining with silver salts, developed so largely by Fajersztajn and Bielschowsky in Germany, and by Ramon y Cajal and Del Rio-Hortega in Spain, are receiving increasing attention. Several procedures have been described for preparing the ammoniacal silver solutions which are used in these methods, and selective staining results have been attributed to each. The conflicting claims have led at times to actual controversy, and the present investigation aims to clarify this subject.1 (1) The method of Fajersztajn,2described in 1901, is of both historical and theoretical interest (as will be shown later). To a weak solution (exact concentration not given) of silver nitrate (AgNo3), Fajersztajn added ammonia until the brown precipitate which formed at first had completely redissolved. He then added more silver nitrate until a precipitate began to form again; the solution, supposedly "freed of excess ammonia" in this way, was filtered through

Atypical neuralgia: unsuccessful attempts to relieve patients by operations on the cervical sympathetic system

Abstract: In the neurosurgical clinic of the University Hospital, major trigeminal neuralgia and atypical forms of neuralgia, because of the wealth of material, have occupied a considerable amount of the time of the attending staff. The files contain records of 1,287 cases, of which 1,083 were classified as typical (major trigeminal neuralgia) and 204 as atypical. Altogether, the major operation has been performed 458 times. I have felt it more or less incumbent to issue a statement as to the nature of these atypical forms of neuralgia (a paper on this subject is in process of preparation) and to publish experiences with operations on the cervical sympathetic system for relief from pain. Sympathectomies of one kind or another might be said to be the last venture in surgery as a means of relieving pain, though years ago Jonnesco proposed removal of the cervical sympathetic ganglion for relief in trigeminal neuralgia. It

A study of the spinal fluid pressure in the differential diagnosis of diseases of the spinal cord

Abstract: The introduction of the lumbar manometric test1of the spinal fluid in the differential diagnosis of diseases of the spinal cord has led to a striking contrast in both the number of laminectomies performed and the pathologic processes found as compared with a similar period before this test had become a routine procedure. Many conditions formerly diagnosed as multiple sclerosis or other inoperable diseases of the spinal cord have been shown to be tumors of the spinal cord or other pathologic processes remediable by neurologic surgery. It is significant that during the three years from 1920 to 1922 inclusive, before the routine introduction of the lumbar manometric test, forty-three laminectomies were performed at the Neurological Institute; whereas during the years from 1924 to 1926 inclusive, when this test had become a routine procedure, ninety-four laminectomies were performed, an increase of 116 per cent. In each of these two three-year

Quantitative studies on human muscle tonus: i. description of methods

Abstract: Methods for the quantitative study of human muscle tonus have been developed along two different lines: 1. Several mechanisms have been designed to give a measurement of the resistance of muscles to pressure on the muscle bellies. There can be little doubt that there is a certain correlation between the hardness of muscles and their ability to resist a stretching pull, but tonus is usually thought of in terms of resistance to stretch so that these methods are obviously indirect unless one defines tonus to mean muscle hardness. At any rate, studies of this sort appear, on the face of them, subject to considerable error because of the necessity of considering the compressibility of extraneous tissues involved in the measurements. No one appears to have followed these methods long enough to have presented a searching analysis of normal muscle compressibility. 2. Several writers have published descriptions of machines with which