http://exhibits.library.stonybrook.edu/mfp/files/original/538bdc6ba0530077be0ac863533401f5.pdf 74bce06bc6e20def0793fd89b0e7d725 PDF Text Text 3mm mam mum mm nwrxrmuox arm: ML. WW4; or A 0A3: MA Mb. (firm) g; (\Mmc ~39:qu QNUULJ».6§~UJ\MA1 4% (0.2.1:? #:g Afod. I751: Viz/b. wk. 316% 3.17/‘3. �1. sustained by patients during hospitalisations' in mental institutions may cause disease of the nervous systemunrelated to the original illness. The trauma may be disregarded and the resulting complications may be interpreted as further progression of the original mental illness, thereby thwarting possible definitive therapy. This is most apt to occur in patients with organic psychoses. For this reason it is felt that a report of a case of subdural heaatcna developing during hospitalization in a patient with organic psychosis will be of Head trauma interest. ‘ fiftyoeight year old white feaale a nurse was admitted to Bellevue Psychiatric Hospital because of aental and personality changes. Four to five years previously the patient began to aislay objects and complained of occasional headaches. During the next two years it was noted that she would repeat herself in conversation, did not play bridge as often as before and complained of a constant feeling of fatigue. One and a half adaission to a marked change in her behavior occurred. years prior She had difficulty in asking decisions, became caliess in her dress, nislaid objects more frequently and exhibited stereotyped HISTGRY: A aoveaents (rubbing hands together, crossing legs) when excited. During the subsequent months she became ”confused" and incontinent. Prior to her illness the patient was a nurse doing private duty and was described as an excellent worker. She was. a happy individual with a pleasant and sociable disposition and had had zany friends. She had been an excellent bridge player, winning aany prises. �2. pressure was 95/60, pulse 88, temperature 98, respirations 18. General physical examination was negative. The patient was well nourished and alert. neurological examination disclosed her to be aphasic and apraetio. There were disturbances in body scheme, a left hononyuous visual field defect was present bu t the remaining cranial nerve functions were intact. There was no ataxia or inooordination. hotor power was noraal. The deep tendon reflexes were active and equal bilaterally and the plantar responses were normal. There was a left henisensory defect to pinpriek and touch. gegggégggz; hunter puncture disclosed clear, colorless fluid under an initial pressure of lho an. containing 5 lymphocytes and a total protein of 62 ng.%. The Hassernann and colloidal gold reactions were negative. X~rays of the skull and chest were negative. in electroencephalogram was diffusely abnormal containing a prevalence of slow activity maximal in the temporal and posterior parietal regions bilaterally. GOURSIa' The differential diagnosis was that of presenile and cerebral neoplasm. A degenerative disease of the brain pneuaoeneephalograa revealed generalised dilatation of the ventricular system without displacement or distortion. The cortical aarkings were increased bilaterally. The patient was kept in the hospital for further study of her mental and sensory defects. On at least one occasion during this period bruises were noted overthe patient's head and fees. these were thought to be sustained tron falls or from busping into objects on the ward. The patient remained alert and no new neurological signs developed. Approximately three EIAIIIAEIOK: Blood ‘ ' �months after admission the patient gradually became lethargic and exhibited rhythmic myoclonio movements, frequent in the corner of the mouth and the left upper extremity and occasional in the right upper extremity. A left hemiperosia developed end the patient became etuporoue. Lumbar puncture diacloeed clear, oolorleee fluid under an initial preeeure or 200 mm. and containing 3 white blood cells. Loft temporal and right A hugh oubdurel henntoma were performed. trephinationo perietal was found on the right eide. It contained dark red, liquid blood. There we: no definite aotive bleeding. The outer membrane one very thin and the inner nenbrene wee inoonepiououe. The right hemisphere wee nerkedly compreeeed and failed to re-expend after evacuation of the hlnmtona. 0n the left side there were two eubdurel membranes about 3~5 mm. apart and oontaining a small amount or yellowish fluid between then. There wee no blood. A cerebral biopsy wee teken.fron the left parietal lobe by introducing a glaee euotion tube for a distance of one inch at a right angle to the eurteoe of the cortexand eepirating a specimen. Following operation the patient became more alert but the apheeie and the disturbance in body scheme were more marked left and epeeoh was unintelligible. The myoolonie movements diaeppeered and the left henipareeie improved. Seventeen days efter operation a pneunoencephelogran showed dilated lateral ventricle: more marked on the left side. The enterior and poeterior horns were aeynaetrioal and slightly diapleoed to the left. The patient died eight days later. An autopsy was not obtained. hieroaeopio examination of the cerebral biopsy at the �shoved numerous senile plaques and time or trephinstion Alzheimer cells, oomputible with the diagnosis of Alzheimer's diseaoe. signs of progreooive diocese of the cerebral hemisphere: which this patient developed during the latter part of hospitalization were initially interpreted as the end stage of an organic psychoaia. In view of the head traumn sustained exclude done subdurel henntonn ward was the on trephination to although this diagnosis was considered improbable. That the subdurel'hanntonntn were of recent origin.end yore not present before hospitalization is demonstrated by the following observations: 1) s pneuloenoophnlogrsn prior to the progression or neurological ventriculnr showed system without a symmetrically dilated signs 'diaplaoinent or distortion and increased cortical markings nontranen the of the hematonats were very thin. 2) bilsterdlly; Patients with organic ptyohosie in nentsl hospitals are psrtioulerly prone to head trauma which may initiate subdursl hemntamn; Progressive usurologioal signs in such patients should be evaluated with this oonsiderstion in mind. The � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Published Works Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Subdural hematoma developing during hospitalization. Arch. Neurol Psychiatry. 1951 Aug; 66(2): 230-1 Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-001-1-001 Date A point or period of time associated with an event in the lifecycle of the resource 1950 Creator An entity primarily responsible for making the resource Green, Martin; <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource Published Works -- Articles and Reviews Relation A related resource The Max Fink Collection Description An account of the resource [Preprint]. 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