226 DISEASES OF THE BRAIN. 



afterward, so that a paresis of the arm and leg is apt to remain. 

 The palsied limbs often move sympathetically, particularly during 

 the acts of coughing and sneezing. Several weeks after the fit 

 there generally occurs a gradually increasing contraction of the 

 crippled limbs (of the hand and arm especially). Thus all the 

 joints of these members become permanently flexed, and this may 

 go so far as to require that the palm of the hand be protected 

 from the impression of the finger-nails. This change from flaccid- 

 ity to stiffness is an evil prognostic sign, meaning that the case is 

 incurable. 



Arthropathy of the hemiplegic, described by Scott Alison, 

 Brown-Sequard, and Charcot, is confined to the palsied limbs, and 

 prefers the arm, and especially the shoulder. This complication, 

 like the contractions, appears several weeks after the fit, and the 

 pain, redness, and swelling are sometimes so marked that the at- 

 tack might be mistaken for acute articular rheumatism, did not 

 the seat of the disease upon a paralyzed limb indicate its true sig- 

 nificance. 



A very rare sequel of apoplexy is a permanent hemi-ansesthe- 

 sia, which persists even after the motor derangement has been 

 restored. This anaesthesia may be complete or incomplete ; it in- 

 volves not merely the skin, but the deeper parts of the lip, tongue, 

 and palate. 



The consequences of an apoplectic stroke, however, are by no 

 means always alike. The situation of the clot may affect the char- 

 acter of the symptoms. While a small extravasation upon the cor- 

 tical substance may cause no recognizable symptoms, a large one, 

 or numerous extravasations in the cerebrum, would be apt to cause 

 mental derangement. There may be stupor, convulsions, delirium, 

 mania, and permanent insanity. Large clots in the posterior brain 

 may cause paralysis or prove speedily fatal. 



Haemorrhagic, embolic, and other lesions affecting the third 

 frontal convolution, particularly those of the left anterior lobe, cause 

 the well-known disturbance of speech known as aphasia, of which 

 more hereafter. Numerous dissections would seem to show that 

 the whole region involving the fossa Sylvii, the island, and the cor- 

 pora striata may be similarly affected by injuries. Apoplexy of 

 the crura cerebri is said to be characterized by marked anaesthesia, 

 slight facial palsy, and squinting, while the psychical functions 

 remain unchanged. 



Apoplexy may result in paraplegia when the lesion is bilateral. 

 In such cases the two sides are usually affected in unequal degree. 

 This very rare consequence of cerebral apoplexy is to be distin- 



