CASE HISTORY

Condition on admission so poor that fill details of history could not be elicited; was stated to have had pains in his legs for many years, - down backs of thigh and along to ankles; also felt on shin; pains worse on going upstairs or walking. For the last few weeks memory had been failing, with loss of ability to concentrate, and had become increasingly unsteady in walking. His wife stated he had had an attack of sciatica 18 months before, from which he recovered partially, sufficiently to do his work. But pain recurred at intervals. For three weeks before admission he had had persistent headaches with vomiting. A week after admission, he fell out of bed during the night, and rapidly became changed mentally and more difficult to manage. Became semi-comatose, dull and restless, continually yawning and moving arms and legs; incontinent of urine, and began to develop a left side hemiplegia. C.S.F. pressure 220mms, protein 200mgs/100cc, Wasserman negative. Coma deepened, and he died twelve days after admission, with a sudden rise of temperature, pulse and respirations.

PATHOLOGY

The specimen consists of the lower halves of the two cerebral hemispheres. At autopsy, the right cerebral hemisphere with the brain in situ was much more bulky than the left. The cut surface shows the great increase in bulk of the right hemisphere to be due to a large glioma which has replaced the posterior parts of the lenticular nucleus and thalamus and the intervening parts of the internal capsule. The growth has pushed the right lateral ventricle over across the middle line, pushing across before it the septum pellucidum and left lateral ventricle. It has also pressed backwards on the posterior horn of the right lateral ventricle, reducing this horn to an elongated chink. The remaining parts of both lateral ventricles were dilated. The growth shows translucent and greyer areas with extensive masses of haemorrhage, mostly recent. Its exact bulk is difficult to determine. As the outline is ill-defined. Higher up the tumour extended into the lower part of the corona radiata.