Neurological symptom

“ The varying degrees in which the various portions of the cortex, medullary portion, and different ganglia of the brain may be involved in the morbid process naturally give rise to a great variety in the symptoms, mental and physical, sensory and motor, emotional and intellectual, and in the relative preponderance of one or another in individual cases. The usual symptoms of any form of mental disease may for a time obscure the dementia which sooner or later must appear in general paralysis, and which, as has already been said, is the only mental symptom universally present in all cases. ”

“ Early physical symptoms are headache, sensations of fulness and pressure in the head, followed by a feeling of dizziness, fatigue, exhaustion, debility, etc. Sooner or later, following a seizure of some kind, neurological signs appear—drooping of the mouth, lateral deviation of the tongue, weakness of an arm, dragging of one leg, loss of sensation on one side, ankle clonus, an increase, decrease or inequality of the patellar reflexes, and sometimes a Babinski reflex. The pupils are very likely to be unequal and sluggish in reaction. ”

“ The onset of general paralysis is slow and gradual, and the earliest symptoms may be either physical or mental. The disease may commence either in the brain itself or the spinal cord may be primarily the seat of lesion, the brain becoming affected secondarily. ”

“ Disease of the cerebral centers may give no further symptom than enfeebled sensibility, which might pass unperceived. Lesions of the motor region often result not in total paralysis but in slight paralysis—a feebleness and not an abolition of the functions. But there are cases where lesions of the sensitive region are accompanied by less equivocal symptoms, and it is from these that we affirm localization. ”

“ Many forms of headache are symptomatic of some organic cerebral disease, like tumor of the brain or syphilitic diseases of the skull. Headache also constantly accompanies fevers of all kinds. A great number of cases are met with in which no cause for the headache can be discovered, and in which the pain is the only symptom. In these there must be some disordered state of the sensory nerves within the cranium, but just what the nature of the abnormal condition is it is impossible to decide. ”

“ From the ascendency of the nervous system in the physical and mental composition, diseases of the nerves are very liable to appear, but not as a primary derangement any more than as a complication grafted upon some previously-existing disease. Nervous headache, neuralgia, epilepsy, insomnia, and hysteria, are among the nervous affections most liable to appear, either as primary or secondary derangements. With this class it is difficult to give an opinion as to the result in any serious disease (prognosis) , as they often die of diseases that in other temperaments are deemed trifling ”

“ Symptoms of Nervous Lesions. The lesions of the brain and spinal cord are usually secondary and often appear when the less dangerous superficial manifestations, are tardy and indolent, when the exudates are indurated and indisposed to soften. There may be violent delirium, pushing of the head against the wall, movements of the limbs as if walking or trotting, roaring, plunging, striking with fore or hind feet, trismus or other muscular spasms. More frequently there is great dulness, prostration, debility, vertigo, drowsiness, amaurosis, paraplegia, general paralysis, coma. ”

“ Pressure on brain—pain, spasm, nausea, dullness, blindness, stupor, coma, palsy. Congestion and anæmia synchronous. Lesions of cortex. Encephalic lesions—hemiplegia, with spasms, increased reflexes, spasms follow cranial nerves, vertigo, apoplexy, epilepsy, dementia, coma, little muscular atrophy, or dermal sloughing. Spinal lesions, paraplegia without spasm, reflex reduced or nil, follow spinal nerves, head symptoms less, much muscular atrophy, bed sores. Sensory and motor tracts, in crus cerebri, respiratory centres—inspiratory expiratory, inhibition. ”

“ As the disease progresses he becomes feeble-minded more and more so continually. Persistent insomnia comes on early and frequently recurring, one-sided headache often goes with it. Sometimes there is an uncontrollable desire to sleep. Loss of consciousness is an early symptom. After severe attacks there may be one-sided paralysis (hemiplegia) which usually disappears in a few hours or days. Convulsions like epilepsy may appear early, but usually occur in the later stages. The pupils are mostly dilated, rarely contracted, and they are often unequal and react slowly to light. ”

“ Among the most unfavorable nervous symptoms are great restlessness, rigid retraction of the head, spasms of other than the spinal muscles, general convulsions, extensive hyperæsthesia, deep coma, dilatation and insensibility of the pupils or their rapid change from a dilated to a contracted state, retention or incontinence of urine, and all cerebral paralyses, including that of the muscles of deglutition. ”

“ A tumor of the brain, if not attended with the common symptom of vomiting, may be the cause of convulsions and headache resembling those often seen in general paralysis. Optic neuritis or atrophy is usual in cerebral tumor, but rare in a stage of general paralysis so early that the diagnosis might be doubtful. ”

“ The more localizing features may be arranged in three groups: intellectual, motor, and sensory.
Intellectual symptoms. The condition of the patient is one of great restlessness, increasing sometimes to actual violence and mania. Attendants are usually required to restrain his movements, and, tossing about in bed, crying out in his pain, muttering and wandering in his delirium, he offers a typical clinical picture of cerebral irritation.
Motor symptoms. The motor symptoms vary according to the region mainly involved, cortex or base. ”

“ According to Cushing, growths in the brain may give rise to no disturbance whatever, show well defined focal signs, occasion only general manifestations, or have both general and focal symptoms, depending on the location of the neoplasm. General symptoms may be briefly summarized as follows:—headache, vomiting, choked disc, vertigo, drowsiness, convulsions, disturbances of the pulse rate, respiration and temperature, as well as mental disorders. The focal signs depend wholly on the site of the growth. ”

“ The great diseases of the brain and spine, such as general paralysis, acute and chronic mania, and others, the author believes will all be shown to be connected with special chemical changes in neuroplasm, and that a knowledge of the composition and properties of this tissue and of its constituents will materially aid in devising modes of radical treatment in cases in which, at present, only tentative symptomatic measures are taken. ”

“ This case, the full significance and interest of which will be better seen when we come to discuss the subject of pathology, is an example of physical changes in the nervous system, which are usually delayed to an advanced period of life, occurring altogether prematurely, and bringing with them a kind of neuralgic pain which is far more common in the decline than in morning of life. ”

“ DEFINITION.—These neural disorders consist of a certain train of nervous symptoms, such as spasm, paralysis, pain, tremor, vaso-motor disturbances, etc., either alone or in more or less complicated combinations, which follow certain muscular acts and are occasionally accompanied by a marked condition of general nervousness; they occur in many of the occupations of every-day life that require for their performance a constant muscular strain combined with more or less delicate movements of co-ordination continued for long periods at a time. ”

“ Neuralgia may be defined as a disease of the nervous system, manifesting itself by pains which, in the great majority of cases, are unilateral, and which appear to follow accurately the course of particular nerves, and ramify, sometimes into a few, sometimes into all, the terminal branches of those nerves. ”

“ If perturbation of nerve-function—a disturbance quite different from mere exaltation of the normal development of nerve-force—be the essence of pain, how comes it that pains of the severest type may be produced by changes in structures which are usually described, for practical purposes, as lying outside the nervous system? We must, in the first place, remark that the externality of any bodily tissue to the nervous system is more apparent than real. ”

“ These two facts suggest a bright as well as a dark view of disorders of the brain and nervous system in early life. If disorder is more frequent, it is excited by slighter causes, is more likely to be temporary, and even its gravest symptoms, such as convulsions and paralysis, have a less serious import in the one case than in the others. If the grown man has a fit, and still more, if that fit is followed by paralysis, we fear and with reason that some vessel in the brain-substance has given way, or that some grave, probably irreparable damage [Pg 89] has been inflicted on it. ”

“ One of these is that, while headache is felt in the head, and particularly in those regions that lie over the brain, the brain has comparatively little to do with the pain. Headache is neither a mark of intellectuality, nor, with rare exceptions, a sign of cerebral disturbance. Indeed, it is far more a matter of the digestion, the muscles, and the ductless glands, than it is of the brain, or even of the nervous system. ”

“ Where syphilitic inflammation is diffused over a considerable portion of the meninges, it is certain very quickly to produce symptoms which can hardly fail to apprise us of the gravity of the affection; there will be decided and rapidly increasing impairment of memory, and general cloudiness of intellect, tending toward complete imbecility, the special senses will be greatly interfered with or lost, and muscular paralysis will be developed. ”

“ The most prominent symptom of a neuralgic attack of the superficial [p. 1212] nerves is of course the pain, and sometimes, from first to last, no other sign of disease is present. In an acute attack the pain is usually ushered in by a sense of discomfort, which the patient vainly tries to shake off, or by a feeling of weight and pressure or of numbness and prickling, or of itching. Sometimes, though far less often than in the case of migraine, there are prodromal signs of a more general character, such as a feeling of thirst2 or of mental depression or drowsiness. ”

“ Somatopsychoses simulate physical and organic nervous troubles. Thus, many “hysterical” forms simulate tabes, or paralysis agitans, hemiplegia, paraplegia, or epilepsy, while many of the neurasthenic, hypochondriacal, and their allied states may simulate tumor, cancer, intestinal and glandular derangements, cardiac, laryngeal, pneumonic, hepatic, splanchnic ovarian, tubal, uterine, renal, and other bodily afflictions.
The neuropsychoses or psychoneuroses simulate all forms of mental disease, beginning with melancholia and mania, and ending with general paresis and dementia. ”

“ That analogous changes take place in the vessels supplying the spinal centres is certain; but it is a remarkable fact that these do not very commonly produce motor paralysis. What they do produce is rather a slow enfeeblement both of (spinal) sensation and motion, but where the process of decay has been prematurely forced, or the inheritance of neurotic weakness is very marked, the process of sensorial decay (the decline, that is, of true sensorial function) is apt to be mingled with pain. ”

“ The more general results are headache, vomiting, optic neuritis and atrophy, slow pulse-rate, somnolence, and coma. The temperature is variable, more commonly rising during the more acute stages of the disease, and falling to normal or subnormal during the quiescent periods.
Localizing features are to be found in squints, inequality of pupils, retraction of the head and neck, dyspnœa, and dysphagia, whilst compression of the cortical motor centres is evidenced by twitchings, convulsions, and spasticity of the limbs. General convulsions are by no means uncommon. ”

“ The frequency of purely nervous symptoms in gouty persons is a fact which is daily brought to the notice of those who have much opportunity to study the disease. These symptoms may be said to affect all the functions of the nervous system; among these we may mention psychical disturbances, such as hypochondriasis and hysteria; derangements of sensation, such as neuralgias and dysæsthesias of every variety; and spasms of voluntary and involuntary muscles, such as cramps, grinding of the teeth, asthma, and vesical tenesmus. ”

“ Symptoms.—May come on suddenly, when it is due to a jar of the brain as well as the cord. Loss of consciousness, complete paralysis, small pulse, collapse, and within a few hours death may follow. In other cases improvement, though very slow, follows. Walking is difficult and the upper extremities are weak in these cases. There are pain and tenderness along the spine. Brain symptoms, such as headache, dizziness and fainting, may be present or absent. ”

“ A dull pain in the head indicates fullness of the blood-vessels from weakness, low blood, or general debility. It may be caused by taking cold, thus producing passive congestion of the brain. It may proceed from gastric disturbance, constipation of the bowels, or derangement of the liver. Heaviness of the head sometimes precedes inflammation of the brain, or chronic disease of its membranes. A dull, oppressive pain in the head indicates softening of the brain, and is generally accompanied by slowness of the pulse and of the speech. ”