View report page

105
Reflex alteralions.—Cervical rigidity is included under this heading, as also is
alteration of tone in the limbs. In the more severe cases there is general flaccidity,
but where the lesion is confined to the subarachnoid space and not invading the
brain tissue, spasticity is found. In this type it is that Kernig and Brudzinski's
signs may be found. The Babinski sign is a variable finding. Other more local
lesions have been described such as hemiparesis motor asphasia.
The presence of fever and the nature of the cerebro-spinal fluid have both
already received attention, but perhaps one of the more curious manifestations that
may present itself to the investigator is the occurrence of albuminuria. It has been
described by certain French writers as massive albuminuria; and, although this may
occur at times, according to the majority of observers it is rare and in some series
of cases no single example could be found
The majority of the first cases described were those that had reached a fatal
termination. Symonds,18 however, pointed out in 1924 that it did not signify that
all the cases ended that way.
Sequelæ and
prognosis.
About 45 to 50 per cent. of the patients in which the aneurysm ruptures die or
the condition. Of the survivors, after a more or less critical illness lasting, perhaps,
for hours, days or weeks, about 30 per cent. recover, never as far as is known to be
troubled again. The remainder are the unfortunate victims of protean sequelae,
varying in severity from occasional headaches to death.
Of the cases that it has been possible to trace over a number of years, many
are found to be quite symptomless. A. J. Hall10 reports a case that lived in good
health for 17 years after her attack of haemorrhage. On the other hand, a surprisingly
large number have second attacks which may come on quite shortly after the primary
haemorrhage or be delayed for periods up to years.
The second lesion is often fatal, though not necessarily so, for J. R. O'Brien19
describes a case where a patient had her first haemorrhage in December, 1926, and
made an apparently good recovery, only to be struck down four months later with
a second attack. The victim became cyanosed, had epileptiform convulsions, and
ran a temperature between 99° and 102° for four weeks, but recovered. One curious
feature about the case, however, was the fact that in a comparatively short period,
the patient put on three stones in weight, and that in 1932, although enjoying good
health, was suffering from pituitary obesity. Another case that was considered to
be making a fair recovery died one month after the initial lesion, and the necropsy
revealed, in addition to recent hæmorrhage in the subarachnoid space, a hæmatoma
in the frontal lobe, which, from its appearance, had been present since the primary
hæmorrhage.
Of the less severe symptoms, headache is the most common, being brought on
by physical effort, mental work, or in some cases, by a "change in the weather."
Of the mental changes themselves, many have been noted.
Partial loss of memory for a period after the catastrophe is not exceptional.23
In addition, loss of memory associated with the recounting of pseudo-reminiscences,
the symptom complex known as Korsakoff's psychosis, has been described by Goldflamm20
as being a sequel of subarachnoid haemorrhage.
Bageley21 has mentioned a case where restlessness, irritability and insomnia
were marked signs, and another observer where the intellectual and emotional
disturbance approached confusional psychosis.
Another victim,23 after a serious haemorrhage during which she was semiconscious
for several days, developed a steadily rising blood-pressure, which commenced
at 140 m.m., hg., and crept up until it reached above 250 m.m., and remained
above 200 m.m. in spite of all measures taken to reduce it.
Some weeks later she developed delusional insanity, which necessitated her
removal to the observation ward.
This gives rise to an interesting point. The majority of the specimens of
congenital cerebral aneurysms in the Royal College of Surgeons museum have been
obtained from the mental hospitals, which leads one to think, in the absence of
other history, as to whether the presence of the aneurysm might not have been