CASE HISTORY

Admitted complaining of weakness of right side of face and right arm and of headache. On 13.7.37 he had collapsed at work and on admission to another hospital was diagnosed as cerebral haemorrhage. He recovered more or less in 14 days, and after a further week returned to work. But he found speech was difficult. his right arm was weak; and there was something wrong with the right side of his face. These symptoms tended to increase. Vomited day before admission and on day of admission. Admitted 16.8.37. On examination speech extremely difficult. Headache present. Flattening of right naso- labial fold with weakness of right side of mouth. Frequent yawning, tongue protruded to the right. Of the cranial nerves, only the 7th right showed weakness. Abdominal reflexes (right) present in upper half abdomen only. Right arm weaker incoordination in movement of small muscles. Knee jerks present and equal. Ankle jerks both absent. 19.8.37. left supra-orbital headache. 20.8.37 became comatose in the afternoon. right knee jerk barely perceptible. Plantar reflexes not elicited. Pupils equal, react to light. Arm reflexes unchanged. Died 12.30am. 21.8.37.

PATHOLOGY

The specimen consists of a vertical slice through the cerebral hemispheres, viewed from behind. The growth is seen to involve the cortex and subjacent white matter of the superolateral surface of the left hemisphere about half way up. It involves the posterior central gyrus. In diameter it reaches up to about 3cm, and is moderately clearly outlined. Part of it is white and opaque, and was fairly firm. Other parts show a gelatinous degeneration, and even small cyst formation. There is recent haemorrhage. In the fresh state, oedema of the surrounding brain for a considerable distance was a very conspicuous feature. The lateral ventricles are distorted, and the convolutions of both hemispheres can be seen to be broadened and flattened from tension.