The results which may be obtained should therefore be considered as follows:--
In 20 cases that have come under my own care, the following results were obtained:--
Cushing reports on 128 cases of traumatic epilepsy, operative measures being adopted in 58, 40 cases of focal epilepsy and 18 exhibiting no localizing feature. The results were as follows:--
12 cases were free from attacks for from 1 to 5 years.
30 were greatly improved or showed some improvement.
=Traumatic insanity.= Traumatic insanity is closely allied to traumatic epilepsy, occurring, as a general rule, late in the history of the case, when the frequency of the fits and the associated disturbance of the higher faculties breaks down the mental and moral control of the patient.
The particular form of insanity varies according to the circumstances of the case. Kraft Ebbing reported on 42 cases, the disease partaking of the following types:--
18 cases of mania. 13 cases of dementia. 5 cases of dementia with epilepsy. 3 cases of general paralysis. 3 cases of melancholia.
16 were of dementia. 29 of mania. 47 of general paralysis. 12 were of epilepsy.
Mania--of a violent type--usually develops within a short time of the accident--a few hours or days. Its development is probably dependent on an _acute cerebral œdema_--the result of a most severe grade of vaso-motor depression--and it is often, though not necessarily, associated with extensive cerebral injury. There is marked engorgement of the cerebral venous system, and considerable increase of cerebro-spinal fluid, both on the surface of the brain and in the ventricular spaces.
When insanity develops at a later date, of whatever variety, it is probably dependent on definite pathological changes. Ll. Powell, Duret, and others, after investigating the conditions, came to the conclusion that the injury was comparatively superficial--subdural cysts and hæmatomata, pachymeningitis, osteosclerosis, ossification of the dura mater, &c. They also maintain--an opinion that I also hold--that the nervous phenomena are, in most cases, due to reflex meningeal irritation.
Ll. Powell reports on 67 cases submitted to operation, with the following results:--
In 41 there was mental recovery. 12 there was marked mental improvement. 5 there was slight mental improvement. 4 there was no change.