The differential diagnosis of a case of epileptiform convulsions / by Byrom Bramwell.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: The differential diagnosis of a case of epileptiform convulsions / by Byrom Bramwell. Source: Wellcome Collection.

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    the attack. Genuine epileptics, too, often feel ashamed of having been observed in a fit. This is not, of course, the case in the feigned disease. 8. The facial appearance of the patient.—Confirmed epil¬ eptics often have a characteristic facial appearance which is difficult to describe. The expression is dull and heavy. Their intellectual powers are generally impaired. When they are undergoing an active course of treatment, the face may be covered with the bromide rash. 9. The effect of proposed energetic treatment,—In sham cases, the proposed removal to the police station, the threat¬ ened application of the actual cautery, &c,, are very efficacious means of arresting the attack, and of making a diagnosis. Having decided that the spasms are genuine, we have next to ascertain their cause; for epileptiform convulsions may be due to a great number of different conditions, amongst which the following are the chief:— 1. Idiopathic (true or genuine) epilepsy. 2. A local “ coarse ” cerebral lesion; including under that term (a) Cerebral tumour. (b) Cerebral abscess. (c) Local meningitis of the convexity. 3. General meningitis. 4. Cerebral haemorrhage (central and meningeal.) 5. Arrest of the blood supply to the brain, as a whole, or of the motor area in particular. (a) General bleeding. (b) Embolism or thrombosis. 6. Reflex irritation, as worms, teething, &c. 7. The presence of certain poisons in the blood and brain; some of the more important being:— (a) Retained urinary products. (b) Alcohol. (c) Lead. (cl) Malarial poison. 8. The onset of the exanthemata and other febrile conditions in children. The diagnosis of the cause of an attack of epileptiform convulsions must obviously, in many cases, be a difficult and tedious operation. The following are the steps in the enquiry which I am in the habit of following out in practice:—