SUPPLEMENT 665 



hemisphere, the medullary substance, the ventricles, the aqueduct, 

 the corpus striatum, corpora quadrigemina, the pineal gland, the pons, 

 the cerebellum, the olfactory trigone, the bulb, the medulla oblongata, 

 and the olive. They are most frequently found in the cortical sub- 

 stance and in the ventricles ; the frequency of the latter situation may 

 be explained by the flow of the fluid (Henneberg 1 ). The severity of 

 the symptoms is not always in proportion to the number of cysticerci. 

 Cases have been known in which ten, twenty and forty cysticerci have 

 been found (Hagen-Thorn 2 ), and yet the clinical symptoms have 

 been remarkably slight. On the other hand, solitary cysts may 

 both run a course completely without symptoms and also cause the 

 severest symptoms when located in specially important parts of 

 the brain (crus, pons, central convolutions). In the case mentioned 

 by Jacobson 3 the invasion of the brain by cysticerci was immense ; 

 the largest cyst was found in the cerebral cortex. The chief 

 symptoms of cysticercus of the brain substance consist in the 

 onset of cortical epilepsy, which sometimes runs a very pernicious 

 course, frequently with psychical disturbances, whilst paralyses are 

 absent. Perhaps, too, the localization of pain, spontaneous and on 

 pressure, corresponding with the points observed on the cranium, 

 is of importance. Cysticerci may also change their position 

 in the brain ; patients who had earlier suffered from epileptiform 

 convulsions later showed intra-ocular cysticerci after the cerebral 

 symptoms had completely disappeared. Treatment can only be 

 surgical ; v. Bergmann* operated in two cases with well-marked 

 improvement. Parasites in the ventricles are especially dangerous, 

 more especially so when free in the ventricles, and so capable of 

 giving rise to the danger of sudden closure of the foramen of Majendie 

 (Simmonds, 5 Verse 6 ). Stern 7 states the symptoms of cysticercus 

 in the fourth ventricle to be the following: general cerebral pressure 

 symptoms (headache, vertigo, vomiting, somnolence, congested disc 

 caused by internal hydrocephalus) ; in addition, there are symptoms 

 which point to disease of the hind-brain pain and stiffness in the 

 neck, vertigo and cerebellar ataxy, violent and persistent vomiting, 

 slowness of pulse ; and lastly those rare but certain symptoms of a 

 lesion of the bulb, such as diabetes, respiratory disturbances and 

 paralysis of cerebral nerves, especially of the abducens. These are 

 far less marked than the general symptoms of cerebral pressure. One 

 characteristic is the remarkable alternation between severe general 



1 Henneberg, Berl. klin. Wochenschr., 1906, xxxii. 



2 Hagen-Thorn, abstract by Posselt. 3 Jacobson, Berl. klin. Wochenschr., 1906. 



4 v. Bergmann, quoted by Fiangenheim, loc, cit., p. 470. 



5 Simmonds, Munch, med. Wochenschr. , 1907, xxvii. 



6 Verse, Munch, med. Wochenschr., 1907, xi. ~ Stern, Zeitschr. f. klin. Med., Ixi. 



