CLINICAL CASES 461 



aches. The patient blamed his left eye, as he said the false image was to the 

 left of the real one. There had been no vomiting or blurring of vision. His 

 speech was normal and memory good. He had had no fits. 



On Examination. — The pupils were equal and reacted to light. There was 

 absence of accommodation and of the upward and downward movements of 

 the eyes. There was some slight ptosis of the left eye and some rotary nystagmus. 



The cranial nerves appeared normal, with the exception of some weakness 

 of the right Vllth, IXth, and Xllth. There was no sensory loss in the arms, 

 but some slight intention tremor. Reflexes were increased in the arms, but 

 were equal on the two sides. There was no weakness of the legs and no sensory 

 loss. Knee and ankle-jerks were brisk and the plantars were extensor in type. 

 There was bilateral papilloedema — right three diopters, left four diopters. 



Fig. 311. — Case 7. 



Photograph of Brain, showing Position of Pineal 



Tumour. 



Lumbar puncture gave a clear, colourless fluid with a pressure of 270 mm. 

 Cells . . . . . . . . . . 10 per c.mm. 



Protein 



Chlorides 



Globulin test 



Sugar 



Culture 



Wassermann reaction 



50 mg. per 100 c.c. 



710 mg. per 100 c.c. 



Negative 



Within normal limits 



Sterile 



Negative 



A radiograph of the skull was normal except for some erosion of the posterior 

 clinoid processes. The visual fields were normal. 



The patient gradually became comatose and paralysed down the right 

 side of the body, and died on 10th March, 1935, some six days after his admis- 

 sion, without any operation being contemplated. 



