THE SYMPATHETIC SYSTEM 203 



insipidus with analogous characteristics to those observed 

 in pituitary syndromes. 



II. SYMPTOMS OF CEREBRAL TUMORS. 



They are explained by the close relationship between 

 the pineal and the neighboring nerve structures. 



This gland is located between the two anterior tuber- 

 cula quadragemina, the posterior portion of the third 

 ventricle, on top of the aqueduct of Sylvius, and below 

 the corpus callosum from which it is separated by the 

 velum interpositum, which contains the veins of Galen. 



A tumor of the pineal gland can sometimes compress 

 the aqueduct of Sylvius which connects the third and 

 fourth ventricle, or the veins of Galen, disturb the cerebro- 

 spinal circulation and cause a marked hydrocephalus. 



If we remember that the anterior tubercula quadra- 

 gemina are in relation with the optic centers and that 

 posteriorly the auditory centers are below them, the gray 

 matter surrounding the aqueduct of Sylvius contains the 

 nuclei of the nerves of the eye (3rd pair in particular), it 

 is easy to see how tumors of the pineal can cause auditory 

 or visual disturbances. 



These patients have a constant headache, very painful 

 and varying in location. (Frontal, occipital or temporal) and 

 cerebral type of vomiting, with stupor, torpor, or narco- 

 lepsia, as the symptoms of intra cranial pressure increase. 



Hydrocephalus is the rule in children below 10 and 

 causes a separation of the cranial sutures appreciable by 

 palpation or X-ray, 



The ocular disturbances are particularly characteristic. 

 In the cases coming early under observation: inequality 

 of the pupils, sluggish reaction of the pupils, a bi temporal 

 hemi-anopsia or blindness depending on the lesions of the 

 tubercula quadragemina being united or bilateral. Some- 



