Cerebrospinal fluid

“ The sulci are widened and the frontal lobes are often noticeably smaller in size. Less frequently the temporal, parietal or occipital regions are affected. Often there are localized foci of atrophy with cyst formation. The ventricles are frequently widely dilated, with an increase of cerebrospinal fluid.
Microscopic examination always shows a more or less diffuse leptomeningitis with a markedly thickened pia infiltrated with lymphocytes and plasma cells. In the superficial layers of the cortex there is a neuroglia proliferation with characteristic "spider cells." ”

“ The diagnosis of cerebrospinal syphilis already suggested by his history was confirmed by the laboratory tests, which showed a positive serum and spinal fluid W. R., paretic gold sol reaction, 41 cells per cmm., an excess of albumin, and a positive globulin test.
1. What is the prognosis in cerebrospinal syphilis in the early secondary stage? The prognosis appears very good provided that intensive treatment be given and provided that no vascular insult or other focal destructive lesion occurs before treatment has had time to do its work. ”

“ In the normal condition it is loosely attached to the brain, from which it can be stripped off without loss of substance. The meshes of the pia, together with the ventricles, constitute a series of cavities connected with each other, containing a variable amount of cerebro-spinal fluid, and they communicate with the lymph-spaces surrounding the blood-vessels. Pressure within the cranial cavity, from congestion of the vessels or from the products of inflammation, is thus relieved in a measure by displacement of the cerebro-spinal fluid, which is driven out through the perivascular lymph-spaces. ”

“ If the fluid be cerebro-spinal in nature, the natural inference is that the subarachnoid space is opened up to the exterior, either directly or indirectly along the course of a cranial nerve. A chemical analysis of the fluid will determine the nature thereof, provided that the fluid be collected EARLY.
Certain factors, however, must be taken into consideration which diminish the value of these chemical tests, for, though the fluid be cerebro-spinal in nature, the admixture of blood at once interferes with the delicacy of the test. ”

“ Relatively to these, therefore, the disease is in a chronic form; and consists, we may repeat, of that lowest degree of inflammation to which serous membranes are subject, and the effect of which is to increase the natural secretion of the part, so as to cause, in regard to the brain, an accumulation of that fluid in its cavities."
Dropsy of the brain is usually divided into three stages. In the first, continues our author, vascular excitement exists, as denoted by pain in the head increasing in acuteness with the increase of the disease ”

“ The cortical [15] substance ran deep into the medullary part of the brain. The ventricles contained about double the usual quantity of water; their parts were all remarkably well defined. The vessels of the pia mater, over the corpora striata, were unusually injected with blood. The velum interpositum was very firm; the plexus choroides uncommonly thick, but pale; the opening from the right to the left ventricle large. The vessels of the brain were generally not much filled with blood.
The blood appeared every where fluid, except in some portions of the lungs, and in the cavities of the heart. ”

“ It is a fact of some importance to know, that cerebral hypertrophy may present symptoms indicative of effusion, and may even terminate fatally, yet without any other morbid appearance than extraordinary development of the brainular mass, and with only very little fluid in the ventricles. Instead of effusion, the convolutions of the brain appear flattened from previous pressure, exhibiting increased density of structure. ”

“ We have seen many cases in which the gold sol was the first test to become negative and others, as the case given, in which it is the last to show any change. As in our undertaker, symptomatic clinical improvement may be practically complete without any change in the spinal fluid tests. ”

“ The brain and its membranes are frequently found in a perfectly healthy state after death from pyæmia, although when the diseased process has extended during the life of the patient to the lungs and pleura, giving rise to great dyspnoea, there will generally be observed some congestion of the membranes, an increased quantity of fluid in the brain-substance and ventricles, and also an increased fulness of the meningeal veins and sinuses. ”

“ The hands are often clenched, and the soles of the feet arched and inverted. The membranes of the brain and of the upper part of the spinal cord are congested; and there is often considerable serous effusions under the spinal arachnoid. The lungs are generally loaded with dark fluid blood. ”

“ No organ possesses a vascular system so delicate and complex as the brain's, nor is there any so sensitive to the action of causes that modify the circulation. For this reason, disorders seated in the brain are peculiarly amenable to electric treatment, and, when carefully applied, it is remedial in brain-fevers, mental delirium, headaches, and sleeplessness. Physicians who first employed the current were quite aware of this benign influence of the galvanic fluid over brain-disorders, and even had the idea of utilizing it in the treatment of insanity. ”

“ The organism may be found in greater numbers in the cerebro-spinal fluid of a case in which the symptoms of sleeping sickness have been developed, though centrifugalization of from 10 to 15 c.c. of the cerebro-spinal fluid for half an hour may be necessary before they can be demonstrated. Greig and Gray, at Mott's suggestion, were able to find the organism in the fluid removed by means of a hypodermic syringe from the swollen lymph glands that appear as one of the earliest signs of infection. ”

“ Dissection of the arteries shows them to be patent and thin walled. Over the cerebrum and cerebellum the pia-arachnoid strips readily leaving a smooth surface. Section of the cerebral cortex, basal nuclei, pons and cerebellum show no gross lesions. The ventricles are moderately distended with fluid. The ependyma contains numerous small cysts. Section of the pons shows no lesions of the nervous tissue, but very marked thickening of the surrounding meninges as noted above. ”

“ Some years later, the German investigator, Quincke, devised a method of puncturing the membrane surrounding the cord, so that he might draw out a few drops of the spinal fluid, to see whether, in such a disease as spinal meningitis, for instance, there were any bacteria present, or whether he could discover any characteristics that would help to diagnose certain obscure cases of disease by observing the pressure of the fluid of the spinal cord. ”

“ The substance of the spinal cord is seldom changed, either in vascularity or in consistence: the morbid changes which this organ undergoes have hitherto been observed only in the membrane that invests it, which, as has been just stated, is not only highly vascular, but likewise contains a much larger quantity of fluid than natural. ”

“ Cerebro-spinal fluid may escape along with the blood, but it is seldom possible to recognise it. If the flow is long continued, the patient may be conscious of a persistent salt taste in the mouth, due to the large proportion of sodium chloride which the fluid contains. In very severe injuries, brain matter may escape through the nose or mouth.
Fracture of the anterior fossa is often accompanied by extravasation of blood into the orbit, pushing forward the eyeball and infiltrating the conjunctiva (sub-conjunctival ecchymosis) . ”

“ The brain is that portion of the cerebrospinal axis within the cranium, which may be divided into four parts—the medulla oblongata, the cerebellum, the pons Varolii, and the cerebrum—and it is covered by three membranes, called the meninges. The outer of these membranes, the dura mater, is a thick, white, fibrous membrane which lines the cavity of the cranium, forming the internal periosteum of the bones; it is continuous with the spinal cord to the extremity of the canal. The second, the arachnoid, is a delicate serous membrane, and loosely envelops the brain and spinal cord ”

“ The cerebrospinal centres are not affected, and the degeneration of the nerve-fibres is more marked the farther they are from the point of origin. The implication of the phrenic and pneumogastric nerves, and of the cardiac plexus, accounts for the breathlessness, palpitation and heart failure; that of the vaso-motor system for the oedema and diminution of urine, and that of the spinal nerves for the loss of power, the impairment and perversion of sensation. According as these nerves are variously affected the symptoms will be modified, some being more prominent in one case and some in another. ”

“ When the cerebro-spinal nerves refuse to perform their function any longer, because the supply of oil is running low, fatigue and sleep ensue, and the blood descends from the brain to the intestines. Thus the cerebro-spinal system is permitted to relax and rest. ”

“ Only too often it results either in paralysis or in death. In many instances, acute cerebrospinal meningitis is changed in this way by drug and serum treatment or by the use of ice bags into the chronic, so-called incurable infantile paralysis. ”

“ The thoracic and abdominal viscera were perfectly healthy.
Upon examining the contents of the cranium, the pia mater was considerably inflamed, and an extravasated blotch, about the size of a shilling, was seen upon that membrane, near the middle of the right lobe of the cerebrum. There was no water between the membranes, nor in the ventricles, but a general determination of blood to the contents of the cranium. The medullary substance, when cut into, was full of bloody points. The consistence of the brain was natural. ”

“ Schiff has shown that galvanization of a cerebro-spinal nerve causes a dilatation of the blood-vessels in the vicinity, as if the vaso-motor force were overpowered by the excessive stimulation of the controlling nerves. If excessive action of the brain or spinal cord be analogous in its effects to galvanism of a spinal nerve, it might be supposed to cause vaso-motor paralysis and hæmorrhage. ”

“ There is a respiratory circulation, the contractile ventral vessel which represents the heart sending the colourless blood forward to the respiratory pharynx to be purified. The body-wall is segmented into over fifty myotomes. There are numerous separate nephridia which develop from the mesoderm and open into the atrium. The brain remains undeveloped, being scarcely distinct from the spinal cord. There are two pairs of cerebral nerves, and many spinal, in which the dorsal and ventral roots or nerves do not unite. The sense-organs are simple; there are no paired eyes and no auditory organs. ”

“ 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. ”

“ Our nerve-arc is not a nervous system. We need only one additional element, however, to form such a system, and this is an ascending or "centripetal" fiber which shall proceed to another collection of cell-matter. In the cerebro-spinal system we have the lowest nerve-arc brought into close anatomical relation with the large cell-mass of the cerebral hemispheres, as well as with the lower cell-masses, by ascending and descending fibers. ”

“ Inflammation may, however, exist in the center of the great nerve masses—the cerebrum, cerebellum, pons Varolii, or medulla at the base of the brain—without involving the surface. When, therefore, inflammation invades the brain and its enveloping membranes it is properly called encephalitis; when the membranes alone are affected it is called meningitis, or the brain substance alone cerebritis. Since all the conditions merge into one another and can scarcely be recognized separately during the life of the animal, they may here be considered together. ”