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tion forms to another group of cases in which the insignificant lesions found do not explain adequately the Buy Mesterolone symptoms observed during life. Oppenheim and Patrick have described cases of this character which they interpret as obscure toxic states stand- ing midway between inflammatory affections of the central gray axis and the asthenic bulbar palsy with- out anatomical findings. These cases are so few in number and so obscure that any generalization is impossible. They suggest, however, the possibility of selective nuclear palsies of toxic origin. The chief interest of the case here recorded, quite typical clinically, is in the nature of the pathological findings. The evidences of hremorrhagic cnceijhalitis while unmistakably present are comparatively slight in degree, suggesting the action of a toxic agent in the production of symptoms. Furthermore the areas of encejjhalitis, while confined to the brain stem, are equally distributed in both the gray and white matter, thus stami^ing the case as a dissem- inated hemorrhagic Mesterolone Online encephalitis as contrasted with a pure polioencephalitis. (From the Cornell Medical Division of Bellez'ite Hospital, service of Dr. H. P. Loomis.) Summary of Case: The patient is a man, aged 40 years, with excessive indulgence in alcohol for many years. Sudden onset after an alcoholic debauch with headaches and vomiting followed by diplopia and par- tial ptosis. Somnolence alternating with periods of great restlessness. Incoherent delirium. Complete external ophthalmoplegia on both sides sparing the sixth nerves. Pupils are unequal, but react. Later bradycardia, irregular respirations, moderate fever, and palsies of the soft palate. Death in coma from respiratory failure. Duration of illness, five days. Clinical Diagnosis: Polioencephalitis acuta supe- rior. Autopsy : Pachymeningitis interna hsemorrhagica unilateralis, with fresh hrcmorrhages into the subdural space. (Edema of the brain, disseminated minute haeni- orrhagic foci, perivascular hemorrhages and small scattered foci of encephalitis, etiually distributed over the gray and white matter of the medulla and pons. The cerebellum, cerebral hemispheres, and basal gan- glia show no evidence of encephalitis. History of Case: The patient was born in Ire- land, is forty years of age, family history negative. He had gonorrhoea at eighteen and a chancre with Generic Mesterolone secondary manifestations at twenty-three. With the exception of the infectious di.seases of childhood, his only illnes.ses have been diphtheria at 20 and ma- laria at 36. For many years his livelihood has been gained doing general work in restaurants and kitchens, affording him unusual opportunities for ex- cessive indulgence in alcohol. He has averaged for some years from ten to fifteen beers and several whis- keys every day, besides numerous debauches. Just be- fore the onset of the present illness he had been drink- ing hard. On Wednesday, October 26, 1904. he awoke in the morning with a severe headache and feeling very tired and languid. He worked all that day and the next, but on Friday, October 28th, the headaches were so severe and the prostration so great that he remained in bed. The headaches continued Friday and Satur- day with great intensity, and were accompanied by vomiting. Sunday. October "joth. he walked to Belle- vue Hospital accompanied by a friend, and was ad- mitted to the Cornell Medical Division, in the service of Dr. H. P. Loomis. On admission he complained bitterlv of headaches, more especially on the right side, vomiting, and great general weakness. Mesterolone Tablets It was noticed 2(JO HUNT: POLIOENCEPHALITIS SUPERIOR. [New York Medical Journal. at this time that the eyelids drooped sUghtly on both sides, more on the right, and diplopia was present. The pupillary reactions were normal. The gait and station showed only a general weakness. The tendon reflexes were exaggerated. The urine was free from albumin or sugar; examination of the thoracic and abdominal organs was negative. Mentally the jjatient was dull and somewhat confused, but responded cor- rectly to all questions. As night approached lie be- came restless and delirious, the temperature reached 100° F., pulse 64, respirations 26. On October 31st the dulness and apathy has in- creased; patient is somnolent and at times almost stuporous. He can be aroused, however, and answers questions distinctly and correctly. The ptosis is now marked on the right side and has increased on the left. The pupils are unequal, the left is the larger, and is

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