His memory grew better from his arrival at a hospital in the rear in April. An attempt was made to remove the bullet in May, 1915. Though the surgeon’s finger was pushed as far as the tentorium the patient did not lose consciousness or sight, but on leaving the operating room he fainted and, after a few days of restlessness and delirium, he became completely blind. There was a cerebral hernia difficult to reduce. Vision became a little better and light and persons could be distinguished at the time when he was retired. A month after the operation there was a convulsive crisis beginning in the left arm, affecting the legs and ending in unconsciousness. Several similar crises occurred in August, sometimes with and sometimes without loss of consciousness. Later these crises began to be limited to the left side and then to be ushered in by visual hallucinations. At home he was unable to care for, clothe or feed himself. The crises became more frequent. The visual hallucinations began to dominate.
This situation lasted to February, 1916, when the blindness which had been increasing since the onset of the hallucinations became complete. The crises now became less frequent and intense. Headaches not severe were exaggerated after seizures. The patient acted like a totally blind person and said that he had before him a uniform and constant gray without any light or dark spots or any color. Upon this background bizarre pictures, caricatures, disguised persons, animals or nameless things appeared colorless without relief, in silhouette, but highly suggestive of reality to such a degree that at first, according to the patient, he had made gestures to reach, or push aside these pictures. The crises were Jacksonian.
Pallor, perspiration, shivering, irresponsiveness, clonic spasms of left arm followed. The patient always had a premonition permitting him to get into bed if he was sitting, for example, in his chair. Sometimes there was a dizzy sensation as if the body were being rotated to the left. This sensation did not occur at the beginning of the seizure and the patient fought against it, turning to the right. Sometimes he felt as if he were sliding at great speed down an inclined plane. Headaches and sleepiness followed, but there was never any complete loss of consciousness of memory.
The eye grounds proved normal and all the photomotor reflexes were normal, though there was no pupil reflex to pain. The patient could write readily to dictation printed letters. It would seem that these printed letters mean that he had visual memories, as he traced the characters as if from a design. Speech was monotonous with some stuttering; but his speech had always been of this sort according to information. He walked with difficulty, not merely on account of his visual but on account of his equilibration disorders. Outside of his seizures he always turned to the right and if left to himself standing he turned to the right. If asked to walk straight ahead, he always turned to the right. Silent and uncommunicative, he was amiable and sometimes even gay. He often had troublous dreams, sometimes seeing his relatives. He said he could bring up in his mind the faces of his relatives and even the appearance of the Salpêtrière. Reflexes and sensations were normal. There was a traumatic rupture of the tympanum. Lumbar puncture showed a slight excess of albumin and 1.8 lymphocytes to the cubic millimeter. The Mauser bullet was found by X-ray in the left calcarine region with its base touching the median line, and applied to the inner table of the skull about a centimeter above the internal occipital protuberance pointing forward, outward, and upward. He was treated on a salt free diet with bromides. The seizures grew fewer and at the time of report two months had elapsed with nothing but a slight vertigo and frequent nightmares. Intellectually also the patient had improved.
The case is one of cortical blindness. The seizures are explained by the vicinity of the right Rolandic region to the lesion. The rotatory vertigo is to be explained by the contact of the Mauser bullet with the tentorium and vermis of the cerebellum, which may also explain the difficulties in orientation that occurred between the crises. The visual hallucinations are doubtless due to lesion of the calcarine region.
Tunisian theopath with mystical hallucinations; gun-shot wound of occiput (bullet extracted): After the trauma, Lilliputian hallucinations and micro-megalopsia.
Case 106. (Laignel-Lavastine and Courbon, 1917.)
A. ben S. was sent to Villejuif with the diagnosis: “depression, feeling of impotence, discouragement,” having been found on the public street. He was indifferent, almost completely mute, and was at first considered not to understand French. In a fortnight, however, he was talking freely and was then found to be afflicted with hallucinations, melancholia, and delusions, apparently following trauma to the skull.
A. ben S. might have been about thirty years old, and was of a rich family, indigenous in Tunis, well educated in the Koran and Arabic literature.