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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    is at an angle of 90° with it. The line of rupture is, however, in the direction of the white mark. Now this appears to have been exactly what happened in the above case—the point of impact was the left parietal eminence, the focus of fracture in the right lamb- doidal suture, and a fissure extended in the direction of, but not as far as, the left parietal eminence. Against this theory it may be urged that the fracture was starred, but when we consider the irregularities present in the suture we can readily imagine how a line of fracture might divide into two; and the gaping of the external aspect of the fracture, together with the slight comminu- tion of the external table, affords evidence, I think, that the frac- ture occurred from within outwards. The most interesting clinical features of this case were the epileptiform convulsions, which corresponded closely with the con- dition so ably described by Hughlings Jackson as indicating lesion of the cortical gray matter, and now well known by the name of Jacksonian epilepsy. The three important points of this affection were very well marked:—(1) The spasm beginning in one group of muscles and gradually spreading in regular order to the other muscles of the same side—in this case the protospasm was invari- ably in the eyes; (2) Paralysis of the affected muscles; (3) The slight degree of insensibility. For the production of this form of epilepsy mere destruction of the cortical substance is not sufficient; secondary changes in the neighbourhood of the injured part appear to be necessary—hence the interval which elapsed between the injury and the onset of the convulsions. The experiments of Hitzig show that removal of a portion of the cortical surface of the cerebral hemisphere in animals was fol- lowed by epilepsy after periods varying from one day to five weeks ; and for the production of these convulsions inflammation does not appear to be essential, and certainly was not present in this case. The changes necessary to repair of the injury would seem in some instances to be sufficient.