Autopsy, March 3, 1907. Four hours post mortem.
Body length, 165 cm. Body of a well developed and well nourished young woman. Lividity in dependent parts. Purplish discoloration of left thigh to knees. Skin rough and scaly. Petechial eruption over chest. Neck thick, protrudes anteriorly. Varicose veins over upper parts of calves on both legs. Eyes protruding, not covered entirely by lids. Pupils equal, dilated. Subcutaneous fat very deep over lower part of body. Very little fat over chest and back. Breasts are very small, apparently atrophied. Normal amount of hair on head, slight amount over pubes. Axillary hair absent. Fat on section of a light yellow color. Omentum extends to pubes, plentifully supplied with fat. Large amount of mesenteric fat. Appendix normal. Intestines smooth and glistening. Slightly injected. No fluid in peritoneum. Uterus small, retroverted.
Cortical hemiatrophy—A, relatively normal right precentral (“motor”) cortex; B, atrophic left precentral.
Note in B:
1. Absence of giant pyramids of Betz (corticospinal, upper motor neurones).
2. Superficial (subpial) condensation of tissues with sclerosis (gliosis). The tissues in all areas examined on the left side yielded this effect.
Head: Hair in good quantity. Scalp normal. Calvarium shows diploë. Dura Mater over left cerebral hemisphere inseparably adherent to calvarium, over right hemisphere normal. Arachnoidal Villi moderately developed. Pia Mater shows injected veins, notably in the sulci of the right hemisphere. Pia mater everywhere thin and clear. Vessels at base of normal appearance.
Brain weight 1180 grams. Spread on a board, the right hemisphere tends to flatten so that it measures 1.5 cm. more from side to side than its fellow. Besides more marked venous injection, the right hemisphere shows also flatter and slightly more plastic convolutions. The posterior poles of the hemispheres are a little firmer than the parts anterior. The orbital and hippocampal gyri on the right side are a little firmer than the surrounding parts. On section the gray and white matter shows no lesions, excepting the slight plasticity of the tissues at large on the right side and a well marked induration, with retraction under the knife, of the occipital and hippocampal white matter. The basal ganglia of the left side are normal. On the right side a sagittal section demonstrates a rounded area of induration, with ill-defined borders, measuring perhaps 1.5 cm. from above downwards by 2 × 2 cm., situated largely in the lenticular nucleus and involving the greater portion of the globus pallidus, a small segment of the putamen below and behind and the regionary part of the anterior commissure with surrounding tissues. The most striking feature of this lesion is the occurrence in the middle of a cluster of vacuoles or cystic clefts, with smooth pale interiors, ranging from pinhead to 0.25 cm. or even 0.5 cm. in greatest diameters. There are six to eight clefts to a surface of section. The color of the lesion differs little from that of the globus pallidus itself, but the tissue is a trifle translucent. It is impossible to demarcate the lesion with the eye. Induration is demonstrable several mm. beyond the visible part of the lesion. The consistence of the lesion slightly surpasses the usual consistence of the olivary bodies.
Cerebellum, Pons and Bulb weight 165 grams. Cerebellar tissue a trifle more plastic than usual. The right olive is not so prominent as usual.
Note. Thyroid: Weight 125 grams. Both lobes and isthmus enlarged. One lobe more than the other; lobe on one side measuring 6 × 4 cm.
Anatomical Diagnoses
Enlargement of thyroid gland.