52 



GILBERT HOREAX 



d. Symptoms Due to Pressure Upon the Cerebellum. The symptoms 

 recorded in some cases of pineal tumors have been so strikingly like those 

 of a cerebellar growth as to make it seem probable tKat the lesion lay be- 

 low the tentorium. Difficulty in walking, amounting even to "drunken 

 gait" was recorded as early as 1837 by Schmidt and spoken of later by 

 Duffin, Nothnagel(&), Howell, and others. It was present in the case at 

 the Brigham Hospital previously referred to. Ataxia of the upper extrem- 

 ities, adiadochokinesia and positive Romberg's sign have been extremely 

 frequent, while Kny and Feilchenfeld give instances of tremor of both 

 hands and body. Oppenheim makes mention specially of vertical nystag- 



Fig. 1. Median section of brain showing tumor of the pineal region; also second- 

 ary ventricular dilatation. (Case reported by the author in 1916.) Reproduced by 

 kind permission of the Archives of Internal Medicine. 



mus, and lateral nystagmus has been recorded by Kny, v. Frankl-Hoch- 

 wart, Bailey and Jelliffe and Oestreich and Slawyk. Many writers speak 

 of retropulsive movements and opisthotonos. 



e. Pressure on Cerebral Peduncles. Tnese structures are involved 

 with great frequency, sometimes singly, but often bilaterally. Lord re- 

 cords a complete left hemiplegia with subsequent involvement of the right 

 leg also, and Pontopiddan speaks of "left motor loss.'' Hyperactive knee 

 and ankle jerks are noted by many authors including bilateral clonus by 

 Schulz and Nothnagel ( & ) . In a recent case, verified by autopsy, there 

 was bilateral spasticity of both lower extremities, simulating experimental 

 decerebrate rigidity. Athetoid movements are described by Lawrence so 

 that in this case, the lesion had probably extended to the basal ganglia, 



3. Constitutional Symptoms. Etiological Considerations. The fore- 

 going recitation of the clinical symptomatology of epiphyseal disease ap- 



