Diseases of the nervous system : a text-book of neurology and psychiatry . athing becomes irregularlyquickened, with spasms and cyanosis. Then spasms of the eyeballsoccur, less often facial spasms. If the pressure is directed downwardtoward the medulla, opisthotonus and muscular rigidity develop, andnot infrequently priapism. MENINGEAL HEMORRHAGE 443 In convexity hemorrhages the child shows considerable restlessness,refuses to suckle, and then develops signs of brain-pressure, pressurein the fontanelles, respiratory disturbances, drowsiness to unconscious-ness, with some slowing of the pulse.
Diseases of the nervous system : a text-book of neurology and psychiatry . athing becomes irregularlyquickened, with spasms and cyanosis. Then spasms of the eyeballsoccur, less often facial spasms. If the pressure is directed downwardtoward the medulla, opisthotonus and muscular rigidity develop, andnot infrequently priapism. MENINGEAL HEMORRHAGE 443 In convexity hemorrhages the child shows considerable restlessness,refuses to suckle, and then develops signs of brain-pressure, pressurein the fontanelles, respiratory disturbances, drowsiness to unconscious-ness, with some slowing of the pulse. Localizing symptoms may thenshow themselves, spasms of the opposite arm and leg, increased tendonreflexes, and slight hypertonus. Diagnosis.—It is extremely difficult to determine whether one hasto deal solely with a pure meningeal apoplexy, or whether there isalso intracerebral disturbance. If there is a definite free interval afterthe initial signs of concussion, with the gradual or sudden onset ofcompression signs, the probabilities are for hematoma (80 per cent.).. Fig. 228.—Traumatic supradural hemorrhage. (Larkin.) The length of free interval offers no certain criterion as to site ofhemorrhage. Choked disk, often transitory, also speaks for spinal fluid, which does not clot, speaks for intradural hemor-rhage, occasionally extradural, Neissers brain puncture and lumbarprocedures often help in clearing up a diagnosis. Long intervalsspeak for abscess. Therapy.—This is surgical and should be immediate. The exactprocedure must be determined largely by the symptoms. Even theintracranial hemorrhages of childbirth may be controlled by skilledsurgical measures. The results of surgical interference are three timesas good as leaving the patients alone. 444 DISEASES OF THE MENINGES Traumatic late apoplexy is a special variety in which degenerativeprocesses complicate the picture. The patients may develop thesigns of hemorrhage, usually intracranially, even month
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