The highly interesting observation has been made by Lionville27 that when miliary aneurisms are present in the brain, they may often be found in the retina also. In one case where they were very numerous in the cerebrum, cerebellum, pons, and meninges, aneurismal dilatations were found also in the pericardium, mesentery, cervical region, and carotids (the latter not being more minutely described). There was very general atheroma and numerous points of arteritis. The retinal aneurisms varied in size from those requiring a power of ten or twenty diameters to be examined up to the size of a pin's head or a millet-seed. He thinks they might have been recognized by the ophthalmoscope.
27 Comptes Rendus de l'Acad. des Sci., 1870.
The hemorrhages accompanying idiopathic anæmia and other diseases with a similar tendency are not to be taken into this account. Hemorrhage accompanying optic neuritis is likely to be due to some disease of the brain other than the one under consideration.
Mental disturbances of various kinds have been considered as significant, and Forbes Winslow gives a great many instances of different forms, but they are to be looked upon rather as indicating chronic cerebral changes which may result in various conditions, of which hemorrhage may be one, than as furnishing any definite indication of what is to be expected. Loss of memory should be regarded in this way. Some acute or temporary conditions of depression may affect the nutrition of the brain in such a way, without having anything to do with hemorrhage actual or anticipated.
Aberrations of the special senses are often observed, such as noises in the ears more or less definite, the sight of colors (red), or being unable to see more than a portion of an object. The fact to which these testify is probably a localized disturbance of the circulation which may not precede rupture of the vessels.
Distinct hallucinations of hearing, followed by those of smell and succeeding irritability, sleeplessness, were observed by Savage28 in a case which terminated soon after in apoplexy.
28 Journ. Ment. Sci., 1883, xxix. 90.
There are few symptoms which are more likely to excite alarm and apprehension of a stroke of paralysis than vertigo or attacks of dizziness, but it is too common under a great variety of circumstances to have much value, and is, as a matter of fact, rarely a distant precursor of intracranial hemorrhage, although it frequently appears among the almost initiatory symptoms, especially when the lesion is in the cerebellum, so that, if continuous, it is not likely to mean that anything worse is coming. It has been said to be strongly significant if occurring without the digestive derangements or circulatory disturbances likely to cause it, and be unconnected with disease of the ear. Unfortunately for diagnosis, but fortunately for the patients, the so-called vertigo a stomacho læso, may arise in cases where the stomach trouble is very difficult or impossible to detect, and it often continues for weeks or months after the most careful regulation of the diet, and yet is followed by no cerebral lesion. Although a vertigo for which every other cause can be excluded certainly justifies a suspicion of cerebral trouble, the tendency to exaggerate its prognostic importance should not be encouraged by the physician, as it may exist a long time, and disappear without another sign of the catastrophe which has been keeping the patient in dread.