BRAIN TUMOR OF PSYCHOMOTOR AREA
Journal of the American Medical Association
CINCINNATI NEUROLOGIC REPORT BY DR. LANGDON The case here reported presents no unusual features pertaining to the growth itself, its localization, the operative procedures or the recovery therefrom. In fact, it may fairly be classed as commonplace in those respects. It had been considered worthy of record, however, by reason of its peculiar symptom-complex, combining marked psychic as well as somatic disturbances; the practical absence of those important "general" symptoms; headache, vomiting,
... eadache, vomiting, vertigo and papilledema ; and the small amount of functional defect remaining at this date (March 16, 1910) four months after operation. History.\p=m-\Nov.5, 1909, Dr. R. B. Hannah,1 of Georgetown, Ohio, asked me to see a woman who had been developing some mental symptoms for a few weeks. It was also stated that preceding these evidences of insanity there had been some convulsive attacks, local and general. The development of the abnormal mental state, however, appeared to be the determining factor in seeking a consultation. Dr. Hannah had been in charge of the case a short time only, and at once recognized the probability of physical disease as a foundation for the nervous and mental manifestations. The patient was a farmer's daughter, aged 39, single, intelli¬ gent and capable up to two years previous to my visit. She had for some years performed important clerical duties as a railway agent and telephone operator at a local station. The family history and surroundings were excellent and prosper¬ ous. There was a history of a blow with a croque! mallet on the left parietal region in childhood. There were no sequela; of importance following this injury: the patient was not unconscious and not confined to the house on account of it. Títere was no scar at the alleged site of the blow. Two years previous to this examination there had been a "jerking" of the right hand and arm. followed in a few moments by "un¬ consciousness." These attacks had been repealed about twenty times in the two years just past. Following them was a progressively increasing weakness of (he right, hand. Two weeks previous to this examination the patient had visual hallucinations and some delusions that surgical operations had been made on her eyes and right leg. First Examination.-This was made at, Hie home of the patient Nov. 5, 1909. The patient was in bed. Consciousness was somewhat clouded, but the patient carried on ordinary conversation fairly well. She appeared mildly elated, m-per¬ haps a state of euphoria would better describe the emotional state. Asked if she sees anything unusual, she answered "Vos; holes in the ceiling and walls; small ones; many of them." There was no defect in ceiling, nor was it papered. There was nothing lo be mistaken for holes; in other words, this was a true hallucination, not an illusion. While the pupillary reactions were being looked for, she volunteered the information that her "eyes had been operated on recently" (probably the opthalmoscopic examination made a few days previously). Asked if anything else had been done, she replied: "Yes, my right leg was cut off recently." This was stated in quite a matter-of-fact manner, without any evidence of regrel or emotion. The patient conversed rationally on many ordi¬ nary topics, but on being questioned as to any speech defect, she said she "loses a word occasionally." Speech tests showed reception and understanding good for ordinary words. Testwords and sentences were repeated correctly and without de¬ fect of articulation. Internal speech appeared good; she could describe objects, letters, words, etc., and tell their meanings, With the practically powerless right hand she could tell the shape of objects, but could not name them (aslereognosis). Owing to weakness in this hand, she could not grasp a pencil.