A mid-brain syndrome following head injury.

HAMORRHAGIC lesions of the brain stem are not infrequently found in fatal cases of accidental head injury. Duret (1878, 1919) emphasized their importance, and showed that they are easily produced in experimental animals. Bemer (1930) and Courville (1945) also considered them to be an important cause of death, and it is clear that only a very few patients who recover from a head injury are found to have the clinical signs of severe brainstem injury. Transient signs of brain-stem injury are, however, not uncommon, and may consist of pupillary and oculo-motor abnormalities or even decerebrate rigidity, while Denny-Brown (1941) has described cases showing delayed collapse after head injury with clinical features indicating bulbar involvement. A few severe cases of mid-brain injury have previously been reported, one of the most striking being by Sachs (1930). The purpose of this paper is to draw attention to a rare type of case in which there is severe and permanent motor disability, probably caused by damage to the mid-brain. Air encephalography carried out in two of the cases showed dilatation of the aqueduct of Sylvius. The nine cases here described were patients in the Military Hospital for Head Injuries, Oxford, and represented a proportion of about one in 700 of the cases of accidental head injury admitted.