A Clinical and Anatomic Study of a Vascular Lesion of Both Cerebellar Hemispheres

Abstract

History.\p=m-\J. E. S., aged 58, a native of Boston, an inmate of the Relief Home, San Francisco, was first examined by me on Dec. 7, 1911. His illness began with a sudden onset three years before, in Japan, without previous ill health or warning. Seated in a tea house in Yokohama, he experienced a sensation as if he were "struck by a ball of lightning in the knees." He arose and attempted to walk, which he was able to do for a distance of about 25 yards, but would then have fallen had he not been aided. There was no loss of consciousness, no pain, headache, nausea or vomiting. Incontinence of urine immediately followed the attack, and later there was imperative micturition. Following the stroke he remained in bed several days. It was at once apparent that control of his left arm and leg was practically lost for all voluntary movements. The right arm and leg were also affected but to a lesser extent. Being right-handed, he could feed himself but with consid¬ erable difficulty. It was not possible for him to walk or even to stand without support, and he would sit all day in a wheel chair. His speech had changed, having become slow and deliberate without any disturbance of pronunciation. Later, hearing and vision were affected; vision was affected for near objects but not for distance. The patient believed that his mentality was as good as formerly, that his memory was as good, and that his disposition had not changed. He was not emotional. There had been no remarkable change in his condition in the three years that had elapsed. He did not complain of weakness, and with the exception of his great loss of muscular control and imperative micturition, he considered himself in average health. The family and previous personal history of the patient were unimportant. Well as a child, his first serious illness was an attack of typhoid in 1898. Venereal infection was denied. He was a total abstainer from alcohol, but smoked in moderation. Examination.-Examination revealed a man apparently of the given age, practically helpless because of great motor incoordination in all extremities * Read at the