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 (iZeprin(^/rom (Ae Montreai Medicai Joumai, May, 1806.) 
 
 CYSTIC TUMOURS OF THE BRAIN FOLLOWING TRAUMA- 
 TISM— JACKSONIAN EPILEPSY— OPERATION- 
 PERFECT RECOVERY.' J 
 By Geobgk E. Armstrong, M.D. 
 
 Assistant Professor of Clinical Surgery, McGill University; Surgeon to the Mont- 
 real General Hospital ; Surgeon to the Western Hospital, Montreal. 
 
 A French boy, aged eight years, was admitted to the Montreal 
 General Hospital complaining of epilepsy and was placed under the 
 care of Dr. F. G. Finley. The following history is taken from the 
 excellent case report of Dr. Gordon Byers. 
 
 When fifteen months old, patient fell down stairs, striking himself 
 with such violence on the side of the head as to produce a hole in that 
 region. He remained unconscious for six days and during that time 
 had a squint of the left eye. He then became quite well again in 
 both mind and body. One month later he began to have convulsive* 
 attacks, accompanied by temporary loss of consciousness. They 
 occurred about once a week and were often accompanied by loss of 
 control over the sphincters of the bladder and rectum. 
 
 At the age of three years these seizures ceased and he became quite 
 well and went to school like other children. 
 
 In January, 1895, i.e., at the age of seven, the condition again came 
 on with increased severity, and as a rule he would have five or six fits 
 in a day if the attacks were mild, three or four if severe. Previous 
 to the onset he does not hear noises, see lights, o».' have any strange 
 sensations, and never knows when the seizures are coming on. The 
 seizures are ushered in by the eyes turning upward, then he stiffens 
 out and falls, the eyes and head turn to the right, clonic spasms come 
 on in the right arm, then in the left, tJien^P-^e legs. 
 
 There is, however, no special orddP^/M invasiea-. Hb '"foams at the 
 mouth and often passes urine and/fs|e|Sh|]M|||^dof!j|^^(,^'j|(|e his tongue. 
 Following the attack he is " sillyMike, "ijQG<($(¥iTO^^n g^es to sleep. 
 
 Occasionally he is sicK at the stom 
 pain in the back of the head. 
 
 of great 
 
2 
 
 During the intervals he is like other children and talks and plays 
 as they do, but is often irritable and cannot be contradicted. 
 
 At four years of age he had a severe form of measles. 
 
 Inquiry into the family history found no record of nervous troubles 
 or tuberculosis. v 
 
 On October 12, 1895, his condition was that of a well-nourished, 
 intelligent French child of eight years. On the head there was seen a 
 depressed area of bone, oval in shape, just above and in front of the 
 horizontal limb of the Sylvian fissure. It measured 3 cm. from above 
 down, 2 cm. from before bacJcwards. The depressed area presented 
 visible pulsation, not diminished by pressure on the occipital and tem- 
 poral arteries. This, however, could only be slightly felt, and on light 
 palpation. . ' . 
 
 Examination of the optic discs showed no evidence of a neuritis or 
 other abnormal changes. j-; , , -< 
 
 The respiratory, vascular, digestive and urinary systems were 
 normal. 
 
 From October 3rd to October 23rd he had six fits, similar in general 
 characters to those described above. 
 
 On October 23rd, 1895, he was given chloroform and the head 
 shaved and prepared as usual for operation. 
 
 An omega-shaped osteoplastic flap was raised and the dura mater 
 found adherent to the opening in the skull. The opening presented a 
 smooth rounded border. There was no bone found to fill this gap, 
 and the conclusion that it was due to pressure absorption seemed the 
 only one possible. Beneath the gap in the skull were found two thin- 
 walled cysts, each containing about one ounce of clear fluid. The 
 portion of the cyst wall in contact with the cerebrum was very thin, 
 transparent and could not bo removed without lacerating the brain. 
 Electrical stimulation of the cerebral cortex in the floor of the cyst 
 and also in the neighbourhood failed to cause any muscular contrac- 
 tion. The osteoplastic flap was repltxced, a special opening being 
 provided for the introduction of an iodoform gauze drain. He made 
 a perfectly smooth recovery. 
 
 He was discharged on the 10th of January, 1896. The sinus was 
 completely closed. The child had had no fit .since the operation and 
 seemed to be in perfect health.