Case of hemiplegic epilepsy following fracture of the skull / by Charles B. Ball.

  • Ball, Charles Bent, 1851-1916.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Case of hemiplegic epilepsy following fracture of the skull / by Charles B. Ball. 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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    This theory is open to some objections. In the first place, the space occupied by the cerebro-spinal fluid is too small and too obstructed by the points at which the convolutions touch tlie arachnoid for any very powerful wave to pass; and, even if we granted that such waves could pass freely, it could not account for the fact that a greater amount of injury is inflicted at the opposite side than at the side struck. M. Gama made a number of experi- ments with glass globes filled with gelatine, and he found, when the vessel was struck a severe and diffused blow, the gelatinous mass separated from the glass to a greater extent at the opposite side, and this fact, although he does not appear to have followed it up, gives, I think, the key to the explanation of injury of the brain by contre-coup. When a person falls heavily on the top of the head the brain is compressed towards the part struck, and separates itself from the base of the skull—a vacuum is therefore left. The internal vascular pressure in the brain is consequently unopposed, and at the same time is increased by the pressure to which the mass of the brain is subjected, and as a result the smaller vessels give way, breaking down the soft gray matter and tearing through the arachnoid, exactly in the same way that we see ecchymosis forming under a cupping glass. A point which was observed in the case above related favours this theory— namely, that the disruption of the gray matter extended down into the sulci between the convolutions, which manifestly excludes any question of pressure against the bone. It is, of course, impossible to test this theory satisfactorily by experiments on the dead body, as the important element of vascular pressure is absent. My colleague, Dr. Purser, kindly drew my attention to a paper by v. Wahl, on fracture of the base of the skull, where he explains certain fractures, in which there is breaking of the skull outwards at an angle of 90° from the part struck. When a semi- elastic sphere is compressed at the poles there is a tendency to a break outwards at the equator, and when a person falls on the head a similar compression takes place between the weight of the body, or even the weight of the head, and the part which is struck. We can easily perform a simple experiment which will more clearly explain this matter. If an orange is thrown forcibly against a white-washed wall we find that the part which strikes the wall can be identified by the white mark, and if it has been thrown with sufficient force to rupture the orange, it will be found that the centre of the rupture does not correspond with the white mark, but