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bursts of high-voltage delta activity in all right-sided leads with phase-reversal in the right temporal region. From the time of admission for four weeks there was a slow, steady deterioration, the ptosis becoming complete and the eyes Aixed except for some downward movement.Bilateral total paralysis of jaw, facial, palatal, and pharyngeal muscles resulted in inability to hold her mouth closed or to lift her head off the pillow. She was unable to swallow or to speak, and deafness was marked. The remainder of the body appeared unaffected and her mental state was quite clear, though to a casual glance she appeared moribund. Nasopharyngeal secretions had constantly to be sucked out, but she would often attend to this herself. She was fed by oesophageal tube twice daily, and the constantly threatening inhalational bronchopneumonia was combated by full chemotherapy and penicillin.After remaining in this state for three weeks, with numerous episodes of respiratory obstruction, each thought to be her lest, she made an indistinguishable sound, and three days later to our astonishment could enunciate recognizable words, while some movement returned to the eyes. After a week she was able to speak sentences, in 10 days was able to swallow fluids, and solids four days later; eye movements were limited only on upward gaze.There was a slow and uninterrupted improvement, but as she became more mobile it was apparent that, though eye movements were normal, and all the motor 'weakness had disappeared, she had developed a Parkinsonian facies with tremor of the head, ,and mild cogwheel rigidity of the limbs with tremor. The cerebrospinal fluid on March 31 was normal apart from the Lange curve, which read 4322100000.Her further progress was followed in the out-patient department, and the Parkinsonian features gradually disappeared. By February, 1950. there was slight immobility only of the face, and six months later she was in all respects quite normal.Comment.-On admission the sensory, cerebellar, and mild pyramidal signs were all on the same side, and, with the gross defects of conjugate ocular movem,nts, pointed to the main lesion being in the tegmentufi of the midbrain, with evidence of involvement of lower centres developing later. It was striking how, at the height of the illness, when the patient was unable to see, speak, swallow, or expectorate the secretions which could be heard rattling in her throat, her mental state was perfectly clear and the power in her limbs excellent. She was very eager to listen to the wireless, and her deafness necessitated its being extremely loud. It was an unforgettable sight to see an apparently moribund patient, her wireless set at full volume, occasionally turning on the motor of the sucker to clear her own nasopharynx.Case 2A male 36-year-old 'works inspector had a history of general malaise and recurrent frontal headache for seven days, and increasing drowsiness for two days during which both lids tended to droop. On March 21,

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Intracranial tumours not uncommonly show their first symptoms, or a rapid increase in their symptoms, during a pregnancy. This occurs more frequently than can be regarded as purely coincidental, and applies to all types of tumour-extrinsic and intrinsic. On questioning a number of medical men it was evident that a popular belief is held that tumours of the pituitary are particularly likely to behave in this manner, but this contrasts with the experience of most neurologists and neurosurgeons who, similarly questioned, would instance meningiomas, angiomas, and occasionally neurofibromas.It is not widely appreciated, however, that such symptoms may show complete remnission following delivery, or, that in the case of certain slowly growing tumours, this sequence of events may recur repeatedly over a very long period, giving rise to considerable confusion in diagnosis.Two striking cases have come under our care at the Midland Centre for Neurosurgery within a few months of each other, in each of which the type and position of the tumour was almost identical. These are recorded below and on extending this study to include other published reports of confirmed intracranial tumours showing repeated relapses and remissions during and after pregnancy, there is found a remarkable uniformity in the clinical picture, the histology, and the site of growth of the tumour.Case Reports Case 1.-A 45-year-old woman was referred complaining of impaired vision in the right eye. Sixteen years earlier, three weeks before the end of her fifth pregnancy, she had developed, quite painlessly, over a period of about three days, complete ptosis of the right eyelid and impaired movement of that eye. This remained until four weeks after delivery and then recovered completely. Five years later, a few weeks before the end of her sixth pregnancy, she again developed right-sided ptosis and partial oculomotor paresis, and again this recovered completely after delivery. Four years later still, three weeks before the end of her seventh pregnancy, exactly the same thing occurred, but recovery after delivery was only partial, and though the ptosis disappeared, she continued to have varying diplopia over the next eight years. During these years the ptosis frequently became complete again three days before menstruation was due and recovered during the week of menstruation. In the last 12 months her vision had begun to fail steadily and it was this that brought her under our care. The whole 16-year course had been completely painless.Examination revealed that vision in the right eye was reduced to finger counting as a result of a large centrocaecal scotoma, and there was papilloedema in that eye. There was a partial right third nerve paresis, with total loss of upward ocular movement, but no other abnormal neurological signs.Radiographs of the skull showed a thickening of the inner end of the right sphenoidal wing and there was a marked difference in the bone density surrounding the optic canals. A diagnosis of sphenoidal wing meningioma was made and a rig...

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