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DOUBLE VISION A SYMPTOM OF DISEASE OF THE BRAIN.

application, aggravated when the patient stoops, and becomes acute under the influence of stimulants.

Dyspeptic symptoms, often accompanying a pain and sickness of the stomach, occur occasionally during the severer paroxysms of cephalalgia. When alluding to these symptoms, Dr. Abercrombie observes, “ after some continuance of fixed headache, the organs of sense become affected, as the sight, the hearing, the taste, and smell, and occasionally the intellect.” The loss of sight generally takes place gradually, being first obscured, and, after some time, entirely lost.

Double vision soon supervenes. This condition may either be permanent or occur at intervals. A remarkable case is on record in which blindness took place rather suddenly, and, after it had continued some time, sight was restored by an emetic. The vision was distinct for an hour, and then, alas! was permanently lost. The intellect is frequently impaired in these cases, and sometimes the speech is lost. The morbid appearances after death present no uniformity.

“ In two cases there were tumours so situated as

directly to compress the optic nerve; in another, a large tumour pressed upon the corpora quadrzlgemina ,- in a third, the disease was situated at the lower part of the anterior lobe; and in another, in which the right eye was affected, it was in the substance of the left hemisphere, near the posterior part. In a case by Drelincurtius, the disease was an enlargement of the pineal gland; and in another case, in which there were both blindness and deafness, a large tumour was found, situated between the brain and the cerebellum.”

Amaurosis is occasionally the effect of local pressure on the optic nerve, or on some portion of the brain in its immediate neighbourhood. This affection arises from

' “ Abercrombie on Diseases of the Brain," p. 318.

organic disease of the cerebellum, as well as the cerebrum, and from lesions in parts of the brain remote from the origin of the nerves of sight. The impairment of vision is often the consequence of white softening, abscess, and atrophy of the brain and other conditions of the tissue connected with disordered states of nutrition. This disorder, however, is not necessarily the effect of congestion, or organic alterations in the optic nerve or thalamus. Andral relates the particulars of several instances of disease of the cerebellum, accompanied by a complete loss of vision. This distinguished pathologist, when referring to these cases, says, “ I am unable to account for the phenomenon. In two out of twelve cases of softening of the cerebellar lobes, blindness existed on the side of the body opposite the lesion.”*

The organic diseases within the cranium, which occasionally produce amaurosis, are such as result from inflammation, softening (acute and chronic) serous efl'usion, induration, abscesses of various kinds, tumours, tuberculous formations, adipose tumours, flesh-like tumours, tumours of a fibro-cartilaginous nature, bony and calcareous concretions, hygromatous tumours, cysts containing a serous or albuminous fluid, hydatids, fungus haematodes, melanosis, haimatomatous tumours, disease of the blood-vessels, aneurismal tumours, thickening of the membranes, depositions of matter between their laminae; dense tumours of a uniform whitish or ash colour, and exhibiting the appearance and properties of coagulated albumen, which are most frequently attached to the dura mater ;- diseases of the cranial bones, osteosa coma, exostosis, &c.

In an amaurotic boy, who was attacked by mania a short time before his death, Beer found a considerable

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AMAUROSIS mom DISEASE or THE BRAIN. 571

spicula at the side of the sella turcz'ca which had penetrated the optic nerve at the chiasma.

The most frequent cause of amaurosis is a seroalbuminous exudation, commonly the result of meningitis, taking place at the base of the brain compressing the chiasma of the optic nerve. The oculo motor nerve, from its close proximity, is generally involved in the disorder, so that convulsions or paralysis of the muscles of the eye are found to co-exist.*

“ Amaurosis from organic disease within the cranium is frequently complicated with epilepsy, apoplexy, paralysis, and afl'ections of the mental powers. It is remarkable that tumours, for example, will be found under the first class, unaccompanied by any remarkable symptoms, while under the second in the same situation, and of no larger size, they were associated with blindness, convulsions, or paralysis.

“ It does not appear that these diversities depend either upon the size of the tumours, or, as far as we know at present, upon their particular structure. But these points remain to be investigated; particularly what diversity of symptoms is connected with the nature of the tumours, and especially with their characters as being tumours distinct from the cerebral mass, or as being indurations of the substance of the brain itself-l

“ The loss of vision, which results from organic cerebral disease, more commonly afl'ects one eye previously to, or independently of, the other; and if both are attacked, the amaurosis is more rapid in one than in the other, but frequently at the commencement of the disease the field of vision is not equally obscure.”1

The patient complains of muscae volitantes, scotoma,

" “A Manual of the Nervous Diseases of Man," by M. H. Romberg, MD. Translated by E. H. Sieveking, M.D., vol. i. p. 232. London, 1853. 1' “ Abercrombie on Diseases of the Brain," p. 322, 323.

I Tyrrell, “ Cyclopmdia of Practical Surgery," vol. i. p. 94.

or sometimes there is increased sensibility to light with luminous spectra and contracted pupil. Not unfrequently objects appear distorted and confused with convulsive movements of the globe or eyelids. As the amaurosis becomes more complete, the vacant stare of the amaurotic patient is evidenced; the pupil becomes widely dilated and motionless, and the muscles convulsed. The eye usually appears on examination free from all organic change, and the retina, as far as can be ascertained, to be perfectly sound in its structure. But the appearance of the eye, and particularly of the pupil, is not to be depended upon, for, although it is usually dilated and immovable, the exceptions are too numerous to admit of its being considered as of uniform occurrence.ii

Sudden loss of sight is occasionally premonitory of apoplexy. A locksmith experienced considerable vertigo for eight days. He then suddenly became blind. He remained in this state of vision for fifteen days, when he was seized with sudden deprivation of consciousness, followed by paralysis. His sight was gradually restored, but the hemiplegia continued.'l

The impairment of vision which so often precedes apoplexy, may exist for some time without being recognised by the patient or his friends in consequence of the defect of sight being limited to one eye, the other compensating, as suggested by Dr. F. Devay (of Lyons), for the weakness of its fellow.

Total loss of sight, unassociated with other symptoms of brain disease, may exist for a long period antecedently to the manifestation of other symptoms of cerebral disorder. Baron Hornestein, whose case is cited by \Vepfer, became blind three weeks before he was seized with a fatal attack of apoplexy}; Dr. Young lost the sight of

i ‘ “ Copland's Medical Dictionary," vol. i. p. 66. 1' Andral. I " Auutomica Apoplecticorum.”

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one eye from tumour of the brain some time before he was aware of the fact. It was not until he applied his eyes to a telescope, and found that the sight of one was entirely lost, that he became acquainted with the morbid state of his visual powers.

The amaurosis, so often associated with morbid states of the brain connected with apoplexy, occasionally continues after the patient recovers from the acute symptoms of the cerebral attack.

A gentleman, after an apoplectic seizure, lost his sight, and continued in a state of perfect blindness for about seven years. After that period, while one day out in his carriage, he suddenly recovered his sense of vision. It was subsequently found that he had entirely retained his skill in drawing, for which he was previously much distinguished.

The late Dr. Gregory, of Edinburgh, was in the habit of mentioning in his lectures the case of Dr. Adam Ferguson, the celebrated historian, as affording one of the strongest illustrations he ever met with of the benefit to be derived from an early attention to the incipient symptoms of cerebral plethora and apoplexy. Dr. Ferguson experienced several attacks of temporary blindness some time before he had an attack of palsy; and he did not take these hints so readily as he should have done. He observed that while he was delivering a lecture, his class and the papers before him would disappear, vanish from his sight, and reappear again in a few seconds. He was a man of full habit ; at one time corpulent and very ruddy, and, though by no means intemperate, he lived freely. I say he did not attend to these admonitions, and at length, in the sixtieth year of his age, he suffered a decided shock of paralysis. He recovered, however, and from that period, under the advice of his friend, Dr._ Black, became a strict Pythagorean in his diet, eating

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