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the cause of the abnormal mental state. It must remain, however, a mere fascinating
speculation, although the case described by Brain and Strauss22 is not without
bearing on the subject. Their patient, who had haemorrhage from an aneurysm on
the anterior cerebral artery which invaded the left frontal lobe, became maniacal
and had to be certified as insane. Later, after release from a mental hospital, she
had a second and fatal haemorrhage.
It is apparent, therefore, that although sequela: may be expected, they are so
widespread in their variety as to render classification a problem of some difficulty.
It nevertheless is apparent that the majority are in the nature of a disturbance of
the higher mental functions.
Once the presence of a congenital cerebral aneurysm is suspected, prognosis
becomes a matter of consummate difficulty.
Not that every case will prove fatal, but that it is impossible to prognosticate
even when a patient has apparently recovered from an attack, whether, if ever, a
second catastrophe might carry him off.
Conclusions.
The congenital theory as to the origin of intra-cranial aneurysms is supported.
The symptoms, as far as it has been found possible, have been classified.
The sequelae have been described and it has been pointed out that in the main
it is on the higher functions that their effects mainly fall.
It is also emphasised that accuracy of prognosis in the early stages is not only
difficult, but in many cases a matter of impossibility.
References.
1 Gray's Anatomy. P. 870, 21st ed., 1920.
2 Winkleman, N. W., and Fay, T. Trans. Ann. Neurol. A., 55, 274-497, 1930.
3 Weed. Physiological Reviews, 1922. Vol. II, pp. 171-103.
4 Gull, Sir William. Guy's hospital reports, 1859.
5 Eppinger. Arch. f. Klin. dict. Vol. 21, 41 p., 1928.
6 Strauss, Globus and Ginsburg. Spontaneous Subarachnoid Hæmorrhage, Arch. Neur. Psych.,
Vol. 27, 1080, 1932.
7 Parkes Weber. Royal College of Surgeons Museum Specimen 4932-2.
8 Green, F. H. K. Quart. Jour. Med., Vol. 21, 41 p., 1928.
9 Greenfield, J. G. International Clinics, Vol. II, lines 39, quoted by Weber and Bode, O.B.
10 Hall, A. J. Lancet, May 25th, 1932 p. 1135.
11 Fearnsides, E. G. Brain, 1916, xxxix, 224.
12 Turn bull, H. M. Quart. Jour. Med., 1915, viii, 201.
13 Forbes, W. B. Aneurysms of the superficial cerebral arteries. Bull. Johns Hopkins hosp., 47,
239, 1930.
14 Charcot and Bouchard. Nouvelles recherches sur la pathologie de P'hæmorrhagie cerebral. Arch, de
physiol. Norm, et Path., 1, 110, 1868.
15 Collier, J., and Adie. Price's medicine, p. 135, 1925.
16 Adie, W. J. Lancet, vol. I, p. 124, 1926.
17 Riddoch, G. Goulden, C.B. Brit. Jour. Ophthal., 1915, ix, 209.
18 Symonds, C. P. Spontaneous Subarachnoid Hæmorrhage. Quart. Journal of Medicine, 18-93, 1924.
19 O'Brien, J. Lancet, June 4th, 1932, p. 1230.
20 Goldflamm, S. Deut. Zeit. v. Nervenheilk. L, xxvi, 58, 1923.
21 Bageley, C. Arch. Neurol and Psych., vol. 27, 1133, 1932.
22 Brain, W. R. Strauss, E. B. Recent advances in Neurology, 1930, 92.
23 Barling, B. London County Council Annual Report, 1930, Vol. iv, part iii, 128-132.