Cerebral anemia

“ Oligocythemia occurs in all but the mildest symptomatic anemias. The blood count varies from near the normal in moderate cases down to 1,500,000 in very severe cases. There is always a decrease of red cells in chlorosis, but it is often slight, and is relatively less than the decrease of hemoglobin. Leukemia gives a decided oligocythemia, the average count being about 3,000,000. The greatest loss of red cells occurs in pernicious anemia, where counts below 1,000,000 are not uncommon. ”

“ At the same time it is only logical to conclude that any morbid condition of the cerebral circulation or of the brain or membranes which leads to a corresponding amount of ventricular effusion, or atrophy or destruction of the nerve centres already designated, will produce the symptoms characteristic of this disease. Thus the different forms of meningitis, traumatic injuries to the cranium, chronic encephalitis, cerebral softening or degeneration, sclerosis, neoplasms of all kinds affecting the brain (cysts, cholesteatoma, psammoma, melanoma, etc.) , and parasites may occasion this disease. ”

“ The chief elements for the formation of the diagnosis are the slow and interrupted progress of the affection, persistent headache, tendency to prolonged slumber, and final coma; the absence of paralysis of the cranial nerves, of vomiting, and of general convulsions; the age of the patient, the coexistence of alcoholism, chronic insanity, or acute rheumatism, and traumatism. The diseases for which hæmatoma would be most likely mistaken are acute inflammation of the meninges, apoplexy from cerebral hemorrhage, tumor in the substance of the brain, and necrobiosis from thrombus or embolus. ”

“ Anatomical changes in the brain or its membranes do exist in a considerable number of cases of chronic Bright's disease. Chronic meningitis with thickening of the pia mater and an increase of serum is quite common; anæmia and oedema of the brain-tissue are often seen. But there are a great many cases with cerebral symptoms without such lesions, and with such lesions without cerebral symptoms. ”

“ In none of the cases I have examined were there any special changes in these organs beyond slight enlargement and filling of the capillaries with leucocytes.
The generative organs are usually normal. No changes have been found to account for the persistent priapism met with in certain cases.
The meninges of the brain, the veins, and sinuses, are often filled with grayish clots. Occasionally meningitis has been found, with exudation of lymph. The small vessels of the brain may be plugged with leucocytes, forming thrombi, from which softening results. Cerebral hemorrhage may prove rapidly fatal. ”

“ Should the cardiac hypertrophy be associated with renal disease, other disturbing elements may be introduced, such as arterio-fibrosis, or the presence in the blood of certain toxic substances having direct effects of their own on the nerve-elements. The picture may be still more complicated by variations in the intracranial pressure. It is impossible to prove, either by direct or indirect evidence, that there is such a pathological state as a simple cerebral hyperæmia; indeed, there is one fact which militates strongly against, if it be not fatal to, such an assumption. ”

“ PRIMARY MENTAL DETERIORATION or PRIMARY BRAIN ATROPHY is a term suggested for a curable impairment of the mind arising from brain-exhaustion in persons, usually men, between the ages of from fifty-five to sixty-five. I have found it in some cases associated with interstitial nephritis and with degenerative disease of the walls of the heart, and have suspected atheroma of the cerebral arteries or possibly endo-arteritis of specific or other origin. It occurs at a time when atrophy of the brain is naturally taking place. ”

“ Aplastic anemia is a potentially fatal disease that results from the bone marrow ceasing to produce formal elements of the blood-the red blood cells, the white blood cells, and the platelets. The disease is responsible for the deaths of 2,000 Americans each year. One-half of the eases of aplastic anemia result from unknown causes. ”

“ Omitting consideration of the syphilitic gold sol of this case, what conclusion could be drawn from the albumin and globulin findings? It would not be warrantable to assume syphilis since it is a common finding after cerebral hemorrhage due to non-syphilitic arteriosclerosis to find excess albumin and also globulin in the spinal fluid. Occasionally, also, pleocytosis occurs in cases of cerebral hemorrhage even when the hypothesis of an active meningitis can be excluded. We may recall in this connection the pleocytosis in so-called meningitis sympathica of certain brain tumors. ”

“ We must, therefore, always take this special duty into consideration, when the question of recuperation, convalescence, feeding, and the administration of blood foods and tonics comes up.
It is not necessary to specify the diseases from which a child may suffer and recover, in an anemic condition. Any disease may leave a child with temporarily poor blood. The conditions which most frequently produce anemia in childhood are improper feeding and unhealthy surroundings. It is not fully appreciated how seriously these conditions can affect the health of growing children. ”

“ Neither will the most indubitable evidence of Bright's disease, such as dropsy, hypertrophy of the heart, rigid arteries, with fatty and waxy casts in the urine, do so, for, as we have already seen, not only is there nothing in the presence of nephritis to exclude apoplexy, but the very form, the interstitial, which, from the supervention of coma not preceded by other very severe symptoms, most nearly counterfeits apoplexy, is also the most likely to give rise to actual cerebral hemorrhage. ”

“ The most usual cause of the disease, however, particularly in children, is an irritation which is sympathetically communicated to the brain, from a disturbance in the chylopoietic organs; and particularly from a functional disorder of the liver. The cerebral disorder, to which a derangement in the digestive functions thus gives rise, is only one of those numerous effects which arise out of sympathies, subsisting between these organs and different parts of the system. ”

“ In such cases the progressive dementia, ataxia, and muscular weakness may advance so slowly as to entirely escape observation for a long time, and give rise to the confident diagnosis of epilepsy for five or six years. Epilepsy, however, arising in a vigorous, middle-aged person without evident cause, should always suggest the suspicion of syphilis, cerebral tumor, or general paralysis, when careful scrutiny of all the symptoms will show where it belongs. ”

“ The dangerous forms of degeneration—the edematous, the cystic, the telangiectatic, and the sarcomatous—occur with sufficient frequency always to be dreaded; and, even though these dangers be avoided, the anemia from the continual hemorrhage exposes the woman to fatal results from the diseases and accidents of daily life. ”

“ The rare and rapidly fatal anemia which has been described under the name of aplastic anemia is probably a variety of pernicious anemia. Absence of any attempt at blood regeneration explains the marked difference in the blood picture. Red corpuscles and hemoglobin are rapidly diminished to an extreme degree. The color index is normal or low. The leukocyte count is normal or low, with relative increase of lymphocytes. Stained smears show only slight variations in size, shape, and staining properties of the red cells. ”

“ It is not difficult to understand why a tumor not destructive to important brain-centres, nor growing sufficiently rapid to produce brain-pressure, yet rapidly enough to compress the blood-channels, may produce symptoms like those of simple cerebral anæmia. It is claimed that with such a tumor the symptoms are aggravated on the patient's lying down, while in simple anæmia they are ameliorated.34 The latter proposition holds good as a general rule ”

“ But when all these conditions have been excluded and when the symptoms are apparently due to a cerebral affection, there is one group of cases in which localizing brain symptoms are absent and in which the chief indications of disease are headache, double optic neuritis, and often vomiting. In most of these cases syphilis can be also excluded. A diagnosis of brain tumor is given, and the growth is thought to be situated in some region in which the localizing symptoms are at first indefinite—cerebellum, temporo-sphenoidal lobe, or prefrontal region. Such a diagnosis often proves to be correct. ”

“ The breath is markedly short and there is often dropsy of the limbs and feet. Fever is often present and quite high. The disease lasts a number of months; the patient often feels better for a time, then relapses into a more serious condition than before.
TREATMENT OF THE VARIOUS FORMS OF ANEMIA
Simple Anemia.—Find the cause and stop it. In infancy special attention should be given to diet and hygiene, giving the child plenty of fresh air, and a change of air to the country or seashore if necessary. The general treatment is more important than any benefit that may be derived from drugs. ”

“ Pathology.—Sunstroke, virtually active congestion of the brain, often accompanied with effusion and blood extravasation, characterizes this condition, with often rapid and fatal lowering of all the vital functions. In many instances the death may be due to the complete stagnation in the circulation of the brain, inducing anemia, or want of nourishment of that organ. In other cases it may be directly due to the excessive compression of the nerve matter controlling the heart's action, and cause paralysis of that organ. ”

“ Sometimes there may be a real disturbance of the circulation from the lack of the heart stimulant to which the system is accustomed and therefore an uncomfortable feeling in the head from brain anemia. ”

“ This is not alone demonstrated by the early symptoms of this disease, but also by the fact, which I have observed in two cases, that where this form of meningitis originates on one side, as from extension of the middle-ear trouble, the opposite cerebral hemisphere exhibited intense congestion of the ideal type.
In that serious form of mental disease known variously as grave or acute delirium and typhomania (Luther Bell) a form of cerebral hyperæmia is observed which in its intensity approximates inflammatory congestion. The surface of the brain appears marbled and mottled ”

“ As a consequence of this tension, the blood-pressure on the brain is well sustained; and a free supply of arterial blood, rendered perhaps more than ordinarily stimulating by the presence of nitrogen in excess, evokes a heightened activity of the cerebral cells. Simple hypertrophy of the heart is mostly found in the subjects of chronic renal changes. That there is a certain explosiveness in the gouty, together with much mental activity, is simply a clinical fact. ”

“ How curious and yet how intelligible is the fact that, though a headache may be induced by even a slight auto-intoxication, an abscess may exist within the brain without causing pain. When an obliterative endarteritis is threatening a leg with anemic gangrene, or when one lies too long in the same position on a hard bed, there is threatening injury from local anemia, and as a result there is acute pain, but when the obliterative endarteritis threatens anemia of the brain, or when an embolism or thrombosis has produced anemia of the brain, there may be no accompanying pain. ”

“ Objectively considered what is observable is hypertrophy of the cellules and nerve-tubes, excessive cerebral plethora and vascularity due to the great efflux of blood and superabundant nutrition of the encephalon. Inflammation of the meningeal covering, and of the brain itself, is, sooner or later, a further result of the chronic congestion. ”

“ The lesson is, that boys who are bleeders may marry, because they will most likely not transmit the disease; but girls who come from a hemophilic family, irrespective of whether they themselves are hemophilics or not, must not marry, because most likely they will transmit the disease.
Anemia
Anemia is a poor condition of the blood. The blood may contain an insufficient number of red blood cells or an insufficient percentage of the coloring matter of the blood, that is, hemoglobin. A special kind of anemia affecting young girls is called chlorosis. ”

“ This is followed [171] by profuse vomiting, after which the temperature begins to rise, the body becomes warmer, and the patient recovers his senses either entirely or in part. The heart beats strongly, the pulse being full and slightly accelerated in rate. The carotid arteries are seen to pulsate forcibly, the face is flushed and moist. The patient is restless, and complains of severe headache, due in all probability to intradural hypertension. Under efficient treatment these symptoms of cerebral hyperæmia abate, the patient recovering quickly or slowly, according to the severity of the blow. ”

“ Since the meninges and choroid plexuses are comparatively bloodless, the cerebro-spinal fluids are more likely to present themselves free from that admixture of blood which renders the obtaining and measuring of their quantity so difficult under ordinary circumstances. The gaping of the sulci has not been verified by me either in animals that had been bled to death or in cases of cerebral anæmia in rapidly-fatal atonic and phthisical melancholia. ”

“ I take up my correspondent’s address at his desire, in the hope of learning something, and this sentence is among the first to catch my eye: ‘Voisin says that in simple insanity he finds certain alterations in the gray matter of the cerebrum, consisting of minute apoplexies, effusions of hæmatin and hæmatosin into the lymphatic sheaths, infarctions, atheroma, capillary dilatations, and necrosis of vessels, and certain changes of cerebral cells.’ Quite so. It may be all very true; but I can offer no suggestions as to medical treatment based [Pg 97] upon these remarkable assumptions. ”