Notes of a case of hemiplegia / by T. Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: Notes of a case of hemiplegia / by T. Lauder Brunton. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in joint. In right leg ankle-clonus well marked. Knee-jerk increased. OEdema of both feet increased. October 20.—Has not slept well during past week. Pulse poorer volume. Seems to be losing ground. October 27.—Takes very badly. Cough very troublesome. Heart murmurs unchanged. Girth 37J inches (increase ^ inch). Liver and spleen as before. Back resonant. Some crepitations and moist sounds at bases. Considerable lumbar oedema. CEdema of legs and feet more marked. Urine sp. gr. 1022; cloud of albumen; amount varies from 8 to 27 ounces. Hst. scoparil November 10.—Cough troublesome last night. Seems sallower to-day. Oedema increased in legs and lumbar region. Heart as before. Some impairment to percussion at both bases, with moist sounds. Girth 40^ inches (increase inch). November 14.—Slept badly and coughed much ; an extra- vasation (slight) of blood and blood pigment has appeared just above and to inner side of left ankle over an area of about 4 square inches. This is extremely tender. November 15.—Patient died to-day. November 16.—Post-mortem examination.—Permission to open the head could not be obtained. External appeao'ance.—OEdema of legs. Abdomen lax and wrinkled. Some jaundice. Head.—Examination forbidden. Spinal cord.—Eight posterior-lateral region appeared rather smaller on section than left, but no grey discoloration to be seen with naked eye. Chest.—Lungs: left nearly normal; right, little inflammatory lymph on surface ; some excess of pleural fluid ; middle part of lung pneumonic, lower part slightly collapsed. No infarction. Heart.—Tricuspid valve slightly thickened ? Mitral well- marked button-hole character, curtains thickened, a small mass of vegetations on auricular side. Endocardium of auricle itself roughened superficially at one point. Ventricular surface of large flap of mitral showed numerous masses of vegetations, one of them, which was hard and rough, was attached by a sort of peduncle to the base of a papillary muscle. The rest more sessile as to their attachment, I'ough and comparatively soft, extended up the mitral flap from its edge to the surface of one of the aortic cusps. Aortic cusps thickened, and from them spring similar vegetations, though in much smaller masses. Muscular tissue pale; some dilatation, but not extreme. Weight of heart 15 oz. Pericardixm, contained clear fluid in excess. Aorta and vessels.—At root of aorta was a small patch where the endothelium was rough and irregular.