The Symptoms of Apoplexy

WARNING: A sensation of weight and fullness in the head; headache and dizziness, especially on stooping; noises in the ears; sometimes temporary deafness; blindness or double vision; frequent nosebleed; nausea; numbness in limbs, especially on one side; incoherent remarks; thickness of speech: drowsiness or stupor; partial paralysis, affecting the face, eyelids or the limbs; heaviness or stiffness in the limbs; slow and irregular pulse; irritability of temper.

MODE OF ATTACK: May begin in three ways. 1. The patient falls suddenly, unconscious and motionless; face flushed; appearance of deep sleep with snoring; pulse full and slow; sometimes convulsions or rigid contraction of the muscles. 2. Sudden pain in the head; faintness; pallor; nausea; sometimes vomiting; sometimes patient falls unconscious; in other cases only slight loss of consciousness, patient suffers with headache and gradually becomes dull, stupid, and finally unconscious. 3. Sudden paralysis of one side; loss of motion but not of consciousness; may come on during sleep, the patient finding one side paralyzed on awakening.

DURING ATTACK: Partial or complete unconsciousness; pulse small at first, generally becomes full and strong and usually slow; sometimes interrupted; respiration slow and snoring; froth about the mouth; cold clammy sweat; face pale; eyes dull and staring, usually looking away from paralyzed side; one or both pupils dilated; teeth set.

Apoplexy is a quite common cause of death, though probably not so common as it is sometimes thought, as many of the deaths attributed to apoplexy are really due to some other cause, particularly disease of the heart. The symptoms described vary in different cases, according to the immediate causes from which they rise and the particular part of the brain affected. In the worst cases of apoplexy the injury to the brain consists in the rupture of a blood-vessel, a clot being formed in the brain-substance by means of which the function of the affected part is destroyed. In some cases the clot formed is so large, and the consequent injury is so great, that instant death occurs. In other cases, death results after a considerable lapse of time through the suspension of certain important functions. In still other cases, death is occasioned by the inflammation itself set up about the clot, which acts as a foreign body in the brain. This inflammation generally begins within from two to eight days after the attack occurs. The milder attacks of apoplexy are occa sioned by the formation of a very small clot or by a sort of concussion of the brain due to sudden and extreme congestion. Cases also occur in which part of the brain becomes suddenly disabled by the blocking up of an artery with a small clot which usually comes from the heart. This, is termed embolism.

The symptoms of inflammation sometimes resulting from the formation of a clot are pain and heaviness in the head, delirium, contraction of the paralyzed limb, especially affecting the flexor muscles, congestion of the face, elevation the temperature with decrease of the frequency of the pulse and respiration. The apoplectic attack may last two or three hours or several days. It finally terminates in one of three ways. It may gradually pass off within a short time, leaving the patient well or nearly so. It may end in partial recovery, the mind remaining somewhat impaired and some parts of the body paralyzed; or it may terminate in death. In the majority of cases there is more or less loss of sensation as well as power of motion in the affected parts. Sensibility returns quite early, however, even when muscular paralysis remains.

Among the symptoms which remain in severe cases after the acute attack is over may be mentioned the following: Paralysis of the limbs, usually affecting the side of the body opposite the point of injury in the brain; that is, if the injury to the brain occurs upon the left side, the paralysis will be upon the right side. The opposite of this is true, however, respecting the muscles of the face. The extensor muscles, or those upon the outer side of the limbs, are generally affected the most seriously. The result of this is contraction of the flexor muscles, which cause various distortions, such as closing of the hand, drawing of the arm toward the opposite side of the body, etc. The arms are generally affected more than the legs; the lower extremities generally recover the most rapidly. According to Trousseau, when the opposite of this is true, the improvement is only temporary, and the patient is almost certain to die within a short time. Paralysis of the tongue is shown by divergence of the organ from the direct line when it is protruded. In severe cases it is protruded with difficulty, and turns toward the paralyzed side. The disturbances of sensation are not always complete paralysis, sometimes being the loss of natural sensibility which is replaced by peculiar sensations, one of the most common of which is that of ants crawling on the skin. This is known as formication. Sight and hearing are sometimes seriously affected. Mental disturbances, sometimes severe, at other times very slight, are generally more or less prominent, being shown in feebleness of intellect, loss of memory, stupidity, childishness, peevishness, irritability, inclination to weep. Sometimes there is gradual loss of intelligence, resulting in imbecility. Insanity rarely occurs. A very common result is loss of memory of words. The patient seems to be able to think correctly but cannot remember the names of objects. If the name is spoken, he will usually recognize it, but cannot speak the word himself when he wishes, though he may be able to repeat it when he hears it spoken. Numerous examinations after death have shown that in these cases there is an injury of a certain portion of the brain upon the left side which is believed to be, in view of the facts stated, the organ of language. Bed-sores sometimes occur upon the paralyzed side within a few days after the attack. Swelling of the joints is also an occasional result.

A person who has had one attack of apoplexy is more liable to another than if he had not had the first attack, and the liability increases with the number of attacks; but the popular supposition that the third is necessarily fatal is an error.

When the person falls in a fit of unconsciousness, it is sometimes difficult to determine whether he is suffering with apoplexy or with some other affection. In some cases, it is impossible to determine at first the real nature of the attack. The flushing of the face, and the slow, full pulse, will generally distinguish apoplexy from fainting, or syncope. The thermometer also furnishes a means for distinguishing it from deep intoxication, as in apoplexy the temperature is always higher than natural, while in a person who is dead drunk, it is a little below the normal standard.