Brain Neoplasm

A patient presenting an unusual clinical picture was recently admitted to the New Haven Hospital. She showed definite objective evidence of involvement of the central nervous system, but other obscure signs present made an accurate diagnosis difficult. At necropsy a most unexpected lesion was found involving the base of the brain, the nerve roots, and the spinal cord. The case is of particular interest because of the correlation between the anatomical and the clinical picture. It is of further interest because of its similarity to a series of 29 cases described by Percival Bailey (Arch. Neurol. and Psych., I925, 4, 192). 'History:-A white, female child of I3 months was brought to the New Haven Hospital on November 22, I928, because of left facial paralysis. Two weeks before admission the child became fretful and the parents noticed an asymmetry of the face. Two days later there was regurgitation of food, failure of the left eyelid to close, and a glassy appearance of the left eye ball. The family physician noted an inequality of the pupils and advised hospitalization. On physical examination the child was fairly well developed and well nourished, but pale and fretful. The temperature was normal and remained so until two days prior to death when it rose to 38.50 C. The pupils were unequal and the left was fixed. There was paralysis of the entire left side of the face and the left half of the tongue was depressed. The swallowing reflex was intact. On the day following admission "pus" which yielded no growth on culture was aspirated from the left middle ear. "Pus" obtained from a mastoidectomy performed a week later also proved sterile. Spinal fluid obtained by lumbar puncture contained 33 lymphocytes and 2 polymorphonuclear cells per cubic millimeter. The second day in the hospital the patient began vomiting which soon became intractable. During the second week in the hospital the child developed