All the other symptoms, as pressing over the peroneal nerve and muscle (Gordon’s sign), which will cause the extension of the toes, the stroking of the anterior tibial surface (Oppenheim’s sign), or the stroking of the region of the external malleolus (Chaddock’s sign), will produce retraction of the toes. All these signs, I say, prove that the upper neuron (within the cranium) is involved. The patient now will lapse into unconsciousness, and be roused with more or less difficulty to again relapse in the same condition. The pupils become sluggish in their action, at first becoming small, then irregular, and finally dilated.
Ophthalmoscopic examination may reveal a choked disk. Spinal puncture shows increased pressure by fluid very frequently coming through the hollow needle with a spurt, and clear or slightly cloudy. Following such a puncture the patient is very often much improved for from a half an hour to a whole day, but the symptoms soon return. A complete examination of the cerebrospinal fluid thus removed, will aid a great deal in diagnosis. This includes the following:
1. Remove about 25 c. c. at spinal puncture.
2. Make several slides and stains for organisms, as septic and tubercular.
3. Examine and count the endothelial cells, leucocytes, and pus cells.
4. Make cultures.
5. Make a Noguchi (butyric-acid) test for excess of albumin.
6. Make a Lange colloidial test.
7. Wassermann, Nonne, and Noguchi tests for syphilis.
8. Test for sugar.