APOPLEXY. 225 



motor nerves as a result of pressure acting on them, but somewhat 

 modified by the tentorium. 



If the patient does not die during the apoplectic fit, but recov- 

 ers consciousness, he shows signs of a more or less severe encepha- 

 litis in a few days. This depends on the injury to the brain from 

 the haemorrhage, hence must be regarded as traumatic. When it 

 does not reach a great height, and only leads to new formations of 

 connective tissue about the clot, the symptoms are increased fre- 

 quence of pulse and other signs of fever, headache, sparks before 

 the eyes, delirium, occasionally also twitchings and contractions of 

 the paralyzed parts. After a time these " symptoms of reaction " 

 moderate and finally disappear, and the patient is well except for 

 the remaining paralysis. But, if the inflammation in the vicinity of 

 the clot is of considerable intensity and induces inflammatory soft- 

 ening, the above symptoms are accompanied by those of general 

 paralysis, and the patient dies as a result of too great severity of 

 the so-called symptoms of reaction. 



[Hemiplegia caused by cerebral apoplexy shows the peculiarities 

 of all cerebral palsies (as contrasted with spinal and peripheral pal- 

 sies). The loss of sensation is less marked and more transitory than 

 that of motion, and the reflex action is almost always preserved or 

 even increased through irritation from the apoplectic centre. Hence 

 a slight increase of electrical irritability argues in favor of a cere- 

 bral palsy. The arm is usually more affected than the leg, and, for 

 a time at least, the tongue and facial muscles are often likewise in- 

 volved. Cerebral palsy of the face especially affects the nervous 

 twigs which supply the muscles of the alae nasi, those of the angle 

 of the mouth, and the buccinator muscles ; while the nerves of the 

 orbicularis palpebrarum almost always escape, so that the eye can 

 always be closed (in contrast to what occurs in peripheral facial 

 palsy). A facial palsy of cerebral origin is upon the same side as 

 that of the hemiplegic limbs ; whereas peripheral palsy of intracra- 

 nial origin (like that by compression of the facial nerve along its 

 course in the base of the skull) is upon the side where the lesion 

 exists. There are often vasomotor disturbances, and the paralyzed 

 side (Eulenburg) shows by the sphygmograph that the arterial 

 tone is sunken and the current retarded, and that the temperature 

 is lower than upon the healthy side ; moreover, the hand and foot 

 are often swollen. The psychical functions also are apt to be more 

 or less altered. 



The derangements which remain after an apoplectic attack has 

 abated may continue to improve for weeks and months ; but where 

 a perfect recovery does* not promptly take place, it seldom does so 



