Shrapnel fragment driven through skull: General paresis.
Case 15. (Hurst, April, 1917.)
A private, 31, was wounded December 7, 1916, by a shrapnel fragment which entered the skull above the left ear and lodged in the brain, an inch above and 2½ inches below the middle of the right orbital margin. At Netley, December 30, he proved to show a complete internal and external left sided ophthalmoplegia, with the exception of the external rectus. On the right side, there was a complete paralysis of the superior rectus and a partial paralysis of the inferior rectus and levator palpebrae superioris. There was a paresis of the left side of the face. The right plantar reflex was said to have been extensor at the clearing station, but at Netley it and the other reflexes proved to be normal, as were the optic. The patient was stuporous and had incontinence of urine and feces for two days. Shortly after admission, slurring of speech with a long latent period occurred. It was clear that the shrapnel fragment must have passed far above the crus, and it was not plain how isolated lesions of the third and seventh nerve nuclei could have been brought about without injury of the long tracts of the crus.
The Wassermann reaction of the serum was negative, but that of the spinal fluid was positive. Iodide and mercury secured considerable improvement in the mental condition and some diminution in the paralysis. The patient is now extremely pleased with himself and has a speech suggestive of paresis.