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7. Neurological Note by Dr. Pattison, August 9, 1932

NEUROLOGICAL NOTE

Aug. 9, 1932.

Dr. Pattison

  • The general appearance is that of a 43 year old American married woman, complaining of headache, failing vision, double vision, right sided weakness, slowness of speech, and general intellectual inefficiency.

    SUMMARY OF POSITIVE FINDINGS

    • Subjective

      1. Headaches of 2 years duration, but have been especially severe within the past 2 months, chiefly suboccipital, and associated with feeling of stiffness in the neck, worse during early morning hours and frequently wakens her up at night.

      2. Failing vision. Vision has been failing off for 2-3 months, and began to cause her alarm early in July of this year. Has noticed difficulty in seeing out of the corners of her eyes, especially the left.

      3. Diplopia. This has been noticed for the first time since admission to the hospital.

      4. Visual hallucinations. These consist of reddish or brown spots floating before the eyes in no special part of the visual fields. During the past 2 weeks she says that she has seen form shadows out of the outer angles of her eyes.

      5. Difficulty in concentration. She has noticed that within the past few months she has become less and less alert, and finds concentration difficult. No subjective impairment of memory.

      6. Slowness of speech. This has been noticed for the past 6 weeks, and is attributed, by the patient, to her mental condition. She has occasional difficulty in finding words to express herself.

      7. Weakness of right side. This was first noticed about 6 months ago in her right hand when she was wringing water out of clothes. Shortly afterwards slight unsteadiness was noted when walking. This weakness of her right side has also been associated with tingling and numbness in her right foot.

    • Objective

      1. A 43 yr. Old married American woman, who is somewhat apathetic and indifferent, and answers slowly and deliberately to questioning.

      2. Visual acuity - V.O.S. 20/100, V.O.D. 20/70 uncorrected.

      3. Bitemporal hemianoptic field defect with scotomata.

      4. Bilateral choked discs, equal on both sides of about 3 D.

      5. Some prominence of eyes and fullness of veins of eyelids.

      6. Some flattening of right side of face, with right lower facial nerve weakness.

      7. Slightly diminished power in right side of body, but without inequality of tendon reflexes.

      8. Right hemi-hypesthesia.

    IMPRESSION

    • The association of papilloedema with bitemporal field defect is confusing. It is significant, however, that her papilloedema has progressed very rapidly during her time in the hospital. In view of her field defects being situated principally in the lower quadrant, it would seem possible that the optic chiasm is subjected to pressure from above. This in association with the rapid development of papilloedema may perhaps point to an obstructive lesion situation in the posterior part of the third ventricle.

    (Dr. Pattison)

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