Читать книгу Shell-Shock and Other Neuropsychiatric Problems - Elmer Ernest Southard - Страница 74

Shell-shock; (apparently slight) scalp wound: Jacksonian seizures. Operation, decompressing the edematous upper Rolandic region. Recovery.

Case 66. (Leriche, September, 1915.)

A Moroccan of the Seventh Tirailleurs was thrown to the ground by the explosion very near him of a large calibre shell, lost consciousness, and woke up with a slight contusion of the right side of the head. The date of this injury is unknown. He was evacuated to the interior, but stopped May 25, 1915, at the evacuation hospital because his pulse in the train stood at 51. An hour later in the hospital he had a Jacksonian epileptic attack, followed by a left-sided flaccid, brachial monoplegia, and after a quarter of an hour a second crisis, and then a third—a sort of epileptic status occupying an hour. The attack seemed to start in the left hand. After the crisis, hand and arm became flaccid and inert.

Lumbar puncture in the crisis gave fluid under small tension in a few absolutely limpid drops. The wound was a superficial skin wound as big as a 25-centime piece, near the middle line, roughly corresponding with the upper Rolandic region. It was hardly a wound—a mild abrasion not passing the epidermis; periosteum and bone intact.

The patient was trephined and a thin layer of clot was found over the dura mater. The clot was removed and a crucial incision was made into the dura mater. The brain seemed a little edematous, hemorrhagic and bruised. It soon began to beat and was tamponed.

May 26, complete brachial monoplegia without seizure.

May 27, seizure at 2 in the afternoon, starting in left arm.

The wound was going well and from this time forward no more seizures. May 28, a cast was made for the hand.

June 4, lumbar puncture yielded a clear liquid under the pressure of 58. That evening an hour after the puncture, the brachial monoplegia disappeared. The arm was still a little weak June 5. June 8 the man was evacuated to the auxiliary hospital at Laversine. June 18, complete recovery.