PAIN REFERRED TO THE EAR
BMJ (Clinical Research Edition)
TMtEDBRilrJUnA many small subpleural haemorrhages. The other organs were normal. Microscopically the appearances were characteristic of encephalitis lethargica. The sections of the mid-brain, pons, and medulla showed the following features: great congestion of all the vessels with infiltration of the perivascular spaces, which were also dilated. This perivascular cuffing wvas most marked in the sections from the pons and medulla. Haemorrhages were seen in various parts, a very large one being
... y large one being present near the lamina terminalis. The ganglion cells in the brain stem showed all degrees of degeneration-some of it pigmentary-and loss of nuclear staining. COMMENTARY Three cases of encephalitis lethargica, proved at postmortem, are described. In all of them there was a prodromal period lasting from one to two weeks, consisting of malaise, headache, lethargy, and constipation. The first case pursued the characteristic course of a subacute disease, with its maximal incidence on the midbrain, spreading thence upwards to the hypothalamic region and basal ganglia, and downwards to the pons and medulla oblongata. Cases II and III were similar to one another in type. Both were remarkable for the fulminating course of the disease once the prodromal period was passed, the acute stage lasting only four days or so. Both showed a complete mental obliteration, and both terminated similarly with a hyperpyrexia.