Medical Terminology for Health

Professions 8th Edition Ehrlich Test

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Chapter 05: The Cardiovascular System

Match each definition with the correct word part.
a. aorta
b. artery
c. plaque, fatty substance
d. blood or lymph vessel
e. slow

1. angi/o
ANSWER: d

2. aort/o
ANSWER: a

3. arteri/o
ANSWER: b

4. ather/o
ANSWER: c

5. brady-
ANSWER: e

Match each definition with the correct word part.

a. blood
b. blood condition
c. mixture or blending
d. heart
e. vein

6. cardi/o
ANSWER: d

7. -crasia
ANSWER: c

8. -emia
ANSWER: b

9. ven/o
ANSWER: e

10. hem/o
ANSWER: a

Match each definition with the correct word part.

a. clot
b. fast, rapid
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Chapter 05: The Cardiovascular System

c. red
d. vein
e. white

11. erythr/o
ANSWER: c

12. leuk/o
ANSWER: e

13. phleb/o
ANSWER: d

14. tachy-
ANSWER: b

15. thromb/o
ANSWER: a

Match each definition with the correct term.

a. blood clot attached to the interior wall of a blood vessel
b. abnormal condition of having a blood clot on the interior wall of a blood vessel
c. blocking of an artery by a blood clot
d. foreign object circulating in the blood
e. sudden blockage of a blood vessel

16. embolism
ANSWER: e

17. embolus
ANSWER: d

18. thrombosis
ANSWER: b

19. thrombotic occlusion

ANSWER: c

20. thrombus
ANSWER: a

Match each definition with the correct term.

a. abnormally low number of white blood cells
b. cancer characterized by abnormal leukocytes
c. mature red blood cells
d. pigment that transports oxygen

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Chapter 05: The Cardiovascular System

e. white blood cells

21. erythrocytes
ANSWER: c

22. hemoglobin
ANSWER: d

23. leukemia
ANSWER: b

24. leukocytes
ANSWER: e

25. leukopenia
ANSWER: a

Match each definition with the appropriate condition.

a. abnormally rapid heartbeat
b. abnormally slow heartbeat
c. abnormal heart rhythm
d. episodes of severe chest pain
e. sudden cessation of the heartbeat

26. angina
ANSWER: d

27. arrhythmia
ANSWER: c

28. bradycardia
ANSWER: b

29. cardiac arrest

ANSWER: e

30. tachycardia
ANSWER: a

Match each definition with the correct term.

a. absence of all formed blood elements
b. abnormally few red blood cells
c. inadequate number of circulating red blood cells due to their premature destruction by the spleen
d. lack of the protein required to absorb the vitamins necessary for the formation of red blood cells
e. larger-than-normal red blood cells

31. anemia
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Chapter 05: The Cardiovascular System

ANSWER: b

32. aplastic anemia

ANSWER: a

33. hemolytic anemia

ANSWER: c

34. megaloblastic anemia

ANSWER: e

35. pernicious anemia

ANSWER: d

36. A/An ____________________ is a localized, balloon-like enlargement of an artery wall.

ANSWER: aneurysm

37. Blood ____________________ is any pathologic condition of the cellular elements of the blood.
ANSWER: dyscrasia

38. The term ____________________ means a condition in which there are an abnormally small number of platelets
circulating in the blood.
ANSWER: thrombocytopenia

39. A/An ____________________ is a medication administered to rid the body of excess sodium and water.
ANSWER: diuretic

40. The term ____________________ is used to describe all the diseases of the heart muscle.
ANSWER: cardiomyopathy

41. A/An ____________________ is commonly known as a clot-busting drug.

ANSWER: thrombolytic

42. A deposit of plaque on or within the arterial wall is known as a/an ____________________.
ANSWER: atheroma

43. The use of electrical shock to restore the heart's normal rhythm is known as ____________________.
ANSWER: defibrillation

44. ____________________ veins are abnormally swollen veins that usually occur in the legs.
ANSWER: Varicose

45. The ____________________ is the double-walled membranous sac that encloses the heart.
ANSWER: pericardium

46. ____________________ hypotension is low blood pressure that occurs upon standing up.
ANSWER: Orthostatic

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Chapter 05: The Cardiovascular System

47. A/An ____________________ blocks the enzyme that causes the blood vessels to contract.
ANSWER: ACE inhibitor

48. The term ____________________ means to stop or control bleeding.

ANSWER: hemostasis

49. ____________________ tachycardia is a very rapid heartbeat that begins within the ventricles.
ANSWER: Ventricular

50. A/An ____________________ is the surgical removal of plaque from the interior lining of an artery.
ANSWER: atherectomy

51. The genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle
shape, is known as ____________________ anemia.
ANSWER: sickle cell

52.
A/An ____________________ is a medication that slows the rate of the heartbeat.
ANSWER: beta-blocker
beta blocker

53. The form of ____________________ known as LDL is harmful because it contributes to plaque buildup in the
arteries.
ANSWER: cholesterol

54. A/An ____________________ is commonly known as a heart attack.

ANSWER: myocardial infarction

55. A/An ____________________ is a medication that slows coagulation and prevents new clots from forming.
ANSWER: anticoagulant

56. An inflammation of the inner lining of the heart is known as ____________________.

ANSWER: endocarditis

57. Chronic ____________________ is a condition in which venous circulation is inadequate due to partial vein blockage
or leakage of venous valves.
ANSWER: venous insufficiency

58. ____________________ is a peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or
stress.
ANSWER: Raynaud’s disease

59. The medical term meaning inflammation of a vein is ____________________.

ANSWER: phlebitis

60. A/An ____________________ is a technique of mechanically widening a narrowed or obstructed blood vessel.
ANSWER: angioplasty

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Chapter 05: The Cardiovascular System

61. ____________________ is the rapid, irregular, and useless contractions of the ventricles.
ANSWER: Ventricular fibrillation

62. A/An ____________________ is a record of the electrical activity of the myocardium.

ANSWER: electrocardiogram

63. A/An ____________________ is the surgical removal of the lining of a portion of a clogged carotid artery leading to
the brain.
ANSWER: carotid endarterectomy

64. ____________________ disease is atherosclerosis of the coronary arteries that reduces the blood supply to the heart
muscle.
ANSWER: Coronary artery

65. The hardening and narrowing of the arteries caused by a buildup of cholesterol plaques is known as
____________________.
ANSWER: atherosclerosis

66. A/An ____________________ is a serious and potentially fatal complication that occurs when the patient’s blood and
the donated blood do not match.
ANSWER: transfusion reaction

67. ____________________ occurs when the normal contractions of the atria are replaced by rapid, uncontrolled
twitching of the muscular heart wall.
ANSWER: Atrial fibrillation

68. An inflammation of a heart valve is known as ____________________.

ANSWER: valvulitis

69. ____________________ is damage to the heart muscle caused by a thrombus blocking a coronary artery.
ANSWER: Coronary thrombosis

70. A potentially life-threatening infection caused by bacteria entering the bloodstream is known as
____________________.
ANSWER: sepsis

71. In a ____________________ stress test, the flow of blood through the heart during exercise is assessed with the use of
the radionuclide.
ANSWER: thallium

72. In case of an emergency, a/an ____________________ can be used by nonprofessionals to externally shock the heart
to restore a normal cardiac rhythm.
ANSWER: automated external defibrillator

73. ____________________ syndrome is a type of cancer in which there is insufficient production of blood cells due to
dysfunction of the bone marrow.
ANSWER: Myelodysplastic

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Chapter 05: The Cardiovascular System

74. A diagnostic and treatment procedure in which a catheter is passed into a vein or artery and then guided into the heart
is known as ____________________.
ANSWER: cardiac catheterization

75. ____________________ is a form of vasculitis that can cause headaches, visual impairment, jaw pain, and other
symptoms.
ANSWER: Temporal arteritis

76. Which condition is an inherited blood disorder that causes mild or severe anemia due to reduced hemoglobin and
fewer red blood cells than normal?
a. dyscrasia
b. leukemia
c. megaloblastic anemia
d. thalassemia
ANSWER: d

77. Which specialist treats diseases and disorders of the blood and blood-forming tissues?
a. cardiologist
b. hematologist
c. vascular surgeon
d. phlebography
ANSWER: b

78. The _____ are only one cell in thickness and are the smallest blood vessels in the body.
a. arterioles
b. venules
c. capillaries
d. coronary arteries
ANSWER: c

79. The condition of having an abnormally slow resting heartbeat is known as _____.
a. atrial fibrillation
b. bradycardia
c. palpitation
d. tachycardia
ANSWER: d

80. The _____ carry deoxygenated blood from the right ventricle to the lungs.
a. pulmonary circulation
b. pulmonary veins
c. pulmonary arteries
d. systemic circulation
ANSWER: c

81. Which term describes a fatty deposit on an artery wall?

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Chapter 05: The Cardiovascular System

a. aneurysm
b. plaque
c. thrombosis
d. embolus
ANSWER: b

82. The highest pressure against the artery walls, which occurs when the ventricles contract, is known as _____.
a. diastolic pressure
b. hypertension
c. hypotension
d. systolic pressure
ANSWER: d

83. _____ strengthens the contraction of the heart muscle, slows the heart rate, and helps eliminate fluid from body
tissues.
a. An ACE inhibitor
b. Digitalis
c. A beta-blocker
d. A diuretic
ANSWER: b

84. Formed in red bone marrow, _____ are the most common type of white blood cells.
a. basophils
b. eosinophils
c. lymphocytes
d. neutrophils
ANSWER: d

85. _____ is plasma fluid after the blood cells and clotting proteins have been removed.
a. Fibrinogen
b. Serum
c. Prothrombin
d. Fibrinogen
ANSWER: a

86. Which of these conditions is also known as a flat line?

a. ventricular fibrillation
b. asystole
c. ventricular tachycardia
d. arrhythmia
ANSWER: b

87. A/An _____ is the condition of having a blood clot attached to the wall of a deep vein.
a. deep vein thrombosis
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Chapter 05: The Cardiovascular System

b. orthostatic hypotension
c. phlebitis
d. peripheral vascular disease
ANSWER: a

88. A/An _____ is a portable electrocardiograph that is worn by an ambulatory patient to continuously monitor heart rate
and rhythm over a 24- or 48-hour period.
a. electrocardiogram
b. stress test
c. Holter monitor
d. thallium stress test
ANSWER: c

89. Which medication is taken in a small daily dose to reduce the ability of the blood to clot?
a. thrombolytic
b. digitalis
c. beta-blocker
d. aspirin
ANSWER: d

90. Which medication is administered to control irregularities of the heartbeat?

a. anticoagulant
b. antiarrhythmic
c. calcium channel blocker agent
d. antihypertensive
ANSWER: b

91. The chronic condition in which the heart is unable to pump out all of the blood it receives is known as _____.
a. heart failure
b. cardiomyopathy
c. coronary artery disease
d. cardiomegaly
ANSWER: a

92. An emergency procedure for life support consisting of artificial respiration and manual external cardiac compression
is known as _____.
a. cardiopulmonary resuscitation
b. artificial pacemaker
c. implantable cardioverter-defibrillator
d. automated external defibrillator
ANSWER: a

93. Which of these tests uses sound waves to image the structures of the blood vessels and the flow of blood through these
vessels?

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Chapter 05: The Cardiovascular System

a. venography
b. digital subtraction angiography
c. diagnostic ultrasound
d. duplex ultrasound
ANSWER: d

94. A _____ is administered within a few hours after a heart attack or stroke to dissolve the damaging blood clots.
a. vasoconstrictor
b. tissue plasminogen activator
c. nitroglycerin
d. aspirin
ANSWER: b

95. A wire mesh tube placed in an artery to provide support to the arterial wall is known as a _____.
a. restenosis
b. stent
c. atherectomy
d. coronary artery bypass graft
ANSWER: b

96. An abnormal increase in the number of platelets in the circulating blood is known as _____.
a. thrombocytopenia
b. polycythemia
c. hemochromatosis
d. thrombocytosis
ANSWER: d

97. Which condition is a form of vasculitis involving several small and medium arteries at the same time?
a. polyarteritis
b. temporal arteritis
c. vasculitis
d. endocarditis
ANSWER: a

98. The abnormal protrusion of a heart valve is known as _____.

a. valvulitis
b. valvular stenosis
c. valvular prolapse
d. heart murmur
ANSWER: c

99. _____ is inflammation of the heart muscle.

a. Carditis
b. Myocarditis
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Chapter 05: The Cardiovascular System

c. Pericarditis
d. Bacterial endocarditis
ANSWER: b

100. Which condition is also known as iron overload disease?

a. hemochromatosis
b. thrombocytosis
c. transfusion reaction
d. anemia
ANSWER: a

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of lesion causing this symptom, some of which have been
reproduced in our table. We will not go into any details as to the
character of this symptom, referring the reader to the sources
indicated. In the first case given in our table (Case 10) the
hemianopsia was produced by a tumor in front of, and impinging
upon, the optic chiasm; in the other four cases (Cases 40, 41, 42,
and 43) the tumor was situated in the occipital lobe, and was
surrounded by an area of destroyed tissue. Hemianopsia is not,
strictly speaking, a symptom of brain tumor, but is likely to be present
in cases occurring in certain regions of the brain. Starr's conclusions
with reference to lateral homonymous hemianopsia when it is not
produced by a lesion of one optic tract are that it may result from a
lesion situated either (1) in the pulvinar of one optic thalamus; (2) in
the posterior part of one interior capsule or its radiation backward
toward the occipital lobe; (3) in the medullary portion of the occipital
lobe; or (4) in the cortex of one occipital lobe. The conclusions of
Seguin are only different in so far as they more closely limit the
position of the lesion.
25 Vol. IV.

26 Pp. 84, 85 of present Volume.

27 Amer. Journ. Med. Sci., N. S., vol. lxxxvii., January, 1884, p. 65.

Phosphenes, or subjective sensations of light, occur in various forms

—simply flashes or sheets of light, scintillations, balls of fire, etc.
They are not very common as isolated phenomena, and probably
are dependent in most cases upon irritation of the nerve and retina in
some of the stages of neuro-retinitis. Even visual hallucinations are
occasionally present, as in one of Bennett's cases of tumor of the
Rolandic region.

Conjugate deviation of the eyes, with rotation of the head, a

symptom of the early stages of apoplectic attacks, is also sometimes
observed in brain tumor. The patient is found with both eyes turned
to one side and slightly upward, as if looking over one or the other
shoulder, the head and neck being usually rotated in the same
direction. Sometimes the deviation is slight, sometimes it is marked.
Frequently the muscles of the neck on one side are rigid. The eyes
are commonly motionless, but occasionally exhibit oscillations. This
sign, well known to neurologists, usually disappears in cases of
apoplexy in a few hours or days, although it occasionally persists for
a long time. It will be more fully considered under Local Diagnosis.

Diminution or loss of hearing, tinnitus, and hyperæsthesia of hearing

are all occasionally observed. The most decided disturbances of this
sense are those which are found in connection with tumors of the
base or of the cerebellum in such a position as to involve the
auditory nerve or auditory tracts. Tinnitus, acoustic hyperæsthesia,
with complete or partial deafness, accompanying facial paralysis,
with or without paresis of the limbs of the opposite side, indicate
clearly a tumor of the base so situated as to involve the superficial
origin or intracranial course of the auditory and facial nerves.

The sense of smell is affected, of course, when the olfactory bulbs

are involved in the growth, either directly or by pressure, as in certain
tumors of the antero-frontal region (Cases 4 and 8). Disturbances in
the power of consciously perceiving odors, or abnormal perceptions
of odors or hallucinations of smell, are sometimes present in cerebral
tumors involving certain convolutions. The lower postero-parietal
region or the temporo-sphenoidal region of the base would seem,
from the few reported cases, to be implicated when this sense is
centrally affected. Smell was lost or impaired in two cases of tumors
of the postero-parietal region, in one limited to the supramarginal
convolutions. In a case reported by Allan McLane Hamilton (Case
47), an induration of the lower part of the right temporo-sphenoidal
lobe involving the uncinate gyrus, the patient, preceding light
epileptic attacks, always had an olfactory aura of a peculiar
character—a disagreeable odor, sometimes of smoke and
sometimes of a fetid character. In this case the olfactory nerves were
examined and found to be healthy.

Taste may be involved in several ways. In the first place, subjective

sensations of taste, particularly the so-called metallic taste, may be
present when the growths involve the cranial nerves in such a way
as to cause irritation to be conveyed to the nucleus of the
hypoglossal. When it is remembered that a mild galvanic current
applied to the nape of the neck or face will often cause this metallic
taste, it can be seen that the irritation of a tumor situated at almost
any point of the base might lead to abnormal taste-phenomena.
Neoplasms involving the trunk of the portio dura may of course
cause diminution or loss of taste on the anterior extremity of the
tongue by the involvement of the chorda tympani nerve. In the very
few cases in which the hypoglossal trunk may be involved
disturbances of taste posteriorly may occur. In two cases (Cases 33
and 36) some possible indications as to the cortical areas of taste
are given. One was a tumor so situated as to cause pressure on the
orbital, and possibly anterior, portion of the temporo-sphenoidal lobe;
the other was a lesion closely localized to the supramarginal lobule.

Trophic disturbances of decided character are sometimes present in

cases of brain tumor. Their presence, character, and extent depend
upon the position of the tumor and the cranial nerves involved.
Trophic disorders of the eye have been noted in cases of tumor of
the antero-frontal region, and also of various positions at the base,
especially those so situated as to involve the trigeminal nerve. In a
fibroma of the superior antero-frontal region (Case 1) conjunctivitis
and corneitis of the left eye, with anæsthesia of the conjunctiva, were
present, and were very marked symptoms. This patient, who was
under the care of one of us at the Philadelphia Hospital, was
examined by O. E. Shakespeare, ophthalmologist to the hospital. At
his first examination the bulbar conjunctivæ were slightly injected
and the cornea clear. The sensibility of the cornea was possibly a
little lowered. Ten days later, at a second examination, the central
corneal epithelium of the left eye was found to be hazy and the
whole bulbar conjuntivæ much congested. “This condition soon
developed into a severe superficial corneitis, which was mainly
limited to a central area of an extent about equal to three-fourths of
the diameter of the cornea, which threatened to slough, a narrow
peripheral ring of the cornea being comparative unaffected. At the
same time the engorgement of the bulbar conjunctiva increased. The
sclera, the iris, and the deeper parts were apparently not involved in
the inflammatory process.”

Disturbances of respiration were observed in a number of cases in

various stages. Cheyne-Stokes breathing was usually a late
symptom. In a case of tubercular meningitis with a tubercular
granulation springing from the left side of the fourth ventricle (Case
82) it was present. Extraordinary slowing of respiration occurred in a
tumor of the right middle cerebellar peduncle and cerebellar
hemisphere which caused irritation and softening of the floor of the
fourth ventricle. The respirations ran as low as four and five per
minute two weeks before death.

Persistent epistaxis and a tendency to hemorrhage from the mucous

membranes were interesting vaso-motor phenomena in a case
situated in the upper left quarter of the pons (Case 84). Profuse
perspiration, more marked on one side, was observed in a case of
tumor in front of the optic chiasm. Polyphagia was observed in two
cases, one a growth of the cerebellum and the other on the floor of
the skull. Polyuria was a very marked symptom in Case 95, a tumor
at the base of the brain at a spot corresponding to the sella turcica,
and diabetes was present in a case of frontal tumor. Albuminuria was
recorded twice—once in the same case in which diabetes was
present, and again in a case of multiple tumor of the supramarginal
convolution of one side and the angular gyrus of the other.
Somnolence was occasionally observed.

Constipation or torpor of the bowels occurs somewhat frequently in

the early stages of the brain tumor, giving place in the terminal
periods to involuntary evacuations. The conditions of the bladder are
practically the same. It is either not involved or suffers from torpor or
paresis of the muscular walls early in the disorder, and later, and
especially very late, incontinence from paralysis of the sphincter
results.

DURATION, COURSE, AND TERMINATION.—The duration of cases of

intracranial tumor is very uncertain. In many of the reported cases no
definite information is given as to the exact length of time from the
initial symptoms until the fatal termination. The few cases in which
the time was recorded showed a duration of from three months to as
many years.

In a few cases, even in some which are not syphilitic in character, a

remission of all the symptoms and what appears to be an
approximate cure sometimes take place, the general symptoms,
such as headache, vertigo, vomiting, spasms, etc., disappearing for
a time. Even the condition of the eyes and the paralysis in rare
instances make marked improvement. In these cases, in all
probability, the progress of the growth of the tumor is arrested either
by the remedies employed or spontaneously, and the acute or
subacute phenomena of congestion, œdema, etc. around the tumor
subside. These patients may remain for a long period or until cut off
by some other disease without any change for the worse; but the
sword constantly hangs above their heads, and any excitement,
traumatism, the abuse of alcohol or other narcotics, an attack of
fever, or some other special exciting cause, may again light up the
intracranial disorder, to then progress more or less rapidly to a fatal
termination.

This fatal termination may occur in various ways. Sometimes a

sudden apoplectic attack occurs. This may be an intercurrent
hemorrhagic apoplexy, although our personal experience would not
lead us to believe this mode of termination is common. In a few
cases the enormous irritation of the cerebral growth suddenly or
gradually inhibits the heart's action through the impression made on
the pneumogastric. Apoplectic attacks which may or may not
terminate fatally sometimes are the result of a sudden giving way of
necrosed brain-tissue, the necrosis having resulted from the
obliteration of numerous blood-vessels by the advancing growth.
Blood-poisoning occasionally takes place from abscesses in
proximity to the tumor. In some cases the patients slowly but surely
emaciate, or are exhausted and worn out by the agonizing pain and
incessant vomiting which they are called upon to endure.
Occasionally a more or less diffused and violent meningitis hastens
the fatal issue.
COMPLICATIONS AND SEQUELÆ.—Tumors of the brain may be
complicated with other affections due to the same cause. Thus, for
example, in a case of gumma other evidences of syphilis may be
present in the form of nodes, eruptions, etc. A sarcoma or carcinoma
of the brain may be associated with similar disease in other organs.
Such affections as cystitis, pyelitis, keratitis, etc., which have been
discussed under Symptomatology, are secondary complications of
cases of tumor. As intracranial tumors almost invariably terminate
fatally, strictly speaking we have no sequelæ.

PATHOLOGY.—We present in tabular form the various classes of

tumors found in the one hundred cases of brain tumor in the table
appended to this article:

Carcinoma 7 Glio-sarcoma 1
Cholesteotoma 1 Gumma 13
Cyst 2 Lipoma 1
Echinococcus 2 Myxo-sarcoma 1
Enchondroma 1 Myxo-glioma 2
Endothelioma 1 Osteoma 2
Fibro-glioma 2 Sarcoma 15
Fibroma 4 Tubercle 13
Glioma 16 Unclassified 16

The histology of tumors of the brain does not in the main differ from
that of the same growths as found in other parts of the body, so that
a detailed description of their structures, even though founded upon
original research, could not offer many novel facts in a field which
has been so thoroughly cultivated. Such a description would
probably repeat facts which have already been presented in other
parts of this work, and which are better and more appropriately put
forth in special treatises devoted to the science of pathology. It is
proper, however, for the sake of convenience and thoroughness, to
make brief mention of the structure of brain tumors, and especially to
dwell upon certain features of these morbid growths which may be
considered characteristic of their encephalic location, and hence
have not only pathological but also clinical interest. It is hardly worth
while to refer to speculations which aim to elucidate the very
foundations of the science, except that in a few of these theories we
gain an additional insight into both the structure and conduct of some
very characteristic brain tumors.

Cohnheim's theory was that tumors are formed from foci of

embryonal tissue which had been non-utilized or left over in the intra-
uterine development of the body. Many have not accepted this idea,
but have rather considered that in tumors we witness a reversion of
tissue to lower or embryonic types.28 Whether we accept either or
neither of these propositions, the idea sought to be conveyed is that
in all these morbid structures we have a tissue of low or degraded
character, springing in most instances from a connective or non-
differentiated tissue. This fact is brought out very clearly in many of
these intracranial growths. Virchow29 has said that tumors originate
in the cells of the connective tissue, although his law has been
condemned as not of sufficient breadth, since it seems to ignore the
epithelial and myomatous tumors. Dermoid cysts, of which an
example is given in the table of spinal tumors,30 are said to illustrate
the embryonic function revived—i.e. the tendency of lower tissues to
spontaneously differentiate into higher and more complex ones.
28 Article “Pathology” in Brit. Encyc., by C. Creighton.

29 Quoted by Cornil and Ranvier.

30 Page 1107.

The gliomata are among the most common and characteristic tumors
of the cerebro-spinal axis, to which system and its prolongation into
the retina they are confined. They invariably spring from the
neuroglia or connective tissue of the nerve-centres, and reproduce
this tissue in an embryonal state. They greatly resemble the brain-
substance to naked-eye inspection, but have, histologically, several
varieties of structure. These variations depend upon the relations of
the cell-elements to the fibres or felted matrix of the neoplasm. In the
hard variety the well-packed fibrous tissue preponderates over the
cell-elements, and we have a tumor resembling not a little the
fibromata (Obernier). The second variety, or soft gliomata, show a
marked increase of cells of varied shapes and sizes, with a rich
vascular supply which allies these growths to the sarcomata. The
elements of gliomata sometimes assume a mucoid character, which
allies them, again, to the myxomata.
 FIG. 43.

Flat Glioma-cell with its Fibrillar Connections (Osler).

FIG. 44.
 (1) Homogeneous translucent fibre-cell; (2) cells like unipolar ganglion-
cells; (3) giant cell (Osler).

W. Osler has recently described31 to the Philadelphia Neurological

Society the structure of certain of these tumors, from which we
abstract the following facts: One point referred to is that gliomata
sometimes contain larger cells and coarser fibres than are usually
shown. The structures are (1) The “spinnen” or spider-cells
(characteristic of glioma), which present variations in size; (2) large
spindle-shaped cells with single large nuclei (some of the largest
cells met with in tumors); (3) cells like the ganglion-cells of nerve-
centres, with large nuclei and one or more processes: some are
balloon-shaped with single processes; they are larger than the
spider-cells; (4) translucent band-like fibres, tapering at each end,
without nucleus or granular protoplasm, regarded as a vitreous or
hyaline transformation of the large spindle-cells. Klebs (quoted by
Osler) holds that the ganglion-like cells are derived from the nerve-
cells of the gray matter, “and that in the development of this variety
all elements of the nerve-tissue participate.” Osler examined the
advancing region of the tumor, and was not able to satisfy himself
that the nerve-cells were in process of proliferation. He thinks they
are connective-tissue elements. He has seen but two out of five
cerebral gliomata which were of small-celled type.
31 “Structure of Certain Gliomas,” Philada. Med. News, Feb. 20, 1886.

The gliomata are subject to fatty degeneration, which usually occurs

in the central (older) portions of the mass. The more vascular forms
are also peculiarly liable to hemorrhage, which is probably caused in
some instances by this process of retrograde metamorphosis. These
hemorrhages resemble apoplexies, not only in their clinical features,
but also on gross examination. Great care is therefore often
necessary at the autopsy to distinguish such a hemorrhage,
occurring as it does in a brain-like neoplasm, from one caused by the
rupture of a diseased artery. The hypertrophy of the pineal gland,
sometimes noted, is caused by the formation of gliomatous tissue.
Under the microscope it is necessary carefully to distinguish some
forms of inflammatory new formations from the gliomata. We have
recently seen, by the courtesy of E. N. Brush of the Pennsylvania
Hospital for the Insane, photographs of microscopic sections from
the ependyma of the lateral ventricles in a case of general paresis,
which showed the structure of this degenerated tissue to be a
compound of fibres and cells of marked resemblance to gliomatous
tissue.32
32 These micro-photographs were prepared in the laboratory of the State Lunatic
Asylum, Utica, New York, by Theodore Deecke.
Sarcomata of the brain are common, as our table shows. In them the
cell-elements predominate, both in the large- and small-celled
variety. They are malignant and grow rapidly. The form known as
alveolar sarcoma, which has a distinct stroma, is to be distinguished
from the cancers; which has probably not always been done.

Tubercle, according to Ross, is the most common of all forms of

brain tumor. Our table shows 13 cases out of 100, the gliomata and
sarcomata being in larger number. Its favorite seat is in the cortex of
both the cerebrum and cerebellum: some observations appear to
show that it is more common in the cerebellum and mid-brain region
than in the fore-brain, and in children than in adults; some of which
points distinguish it from the gummata, which are more common in
adults and occur anywhere. Tubercle is another form of development
from the connective tissues, usually dependent upon a constitutional
taint or predisposition: in it the cell-elements have generally
undergone a degeneration into an amorphous cheesy mass. It is apt
to be multiple and accompanied by a similar deposit in other organs
of the body.

True neuromata are probably very rare growths, and it is likely that
some tumors which have been described as such are really
connective-tissue tumors of a gliomatous nature, in which some of
the cell-elements have been mistaken for the ganglion-cells.
Obernier33 says that these tumors are small and grow from the gray
matter on the surface, also on the ventricular surfaces. They are also
found in the white matter. He says they are only found in persons
having some congenital or acquired aberration; by which is probably
meant some other well-marked neurosis or psychosis. The one
hundred tabulated cases afforded no examples of neuromata.
33 Op. cit.

Myxomata are not, histologically, to be distinguished from the

gliomatous tissues by anything but the peculiar mucoid changes
which their structures have undergone. They are more rare in the
brain, as our tables show, than in the spinal cord.
Lipomata are very rare in the brain, according to most observers.
The table shows but one example. These tumors, as their name
signifies, are made of fat-bearing tissues—another of the connective-
tissue class.

The angiomata, somewhat rarely found within the skull, are noted for
their abnormal development of the vascular tissues: they are
composed mainly of blood-vessels and the connective tissue, which
supports them in closely-packed masses. They also present
cavernous enlargements. They are of especial interest in cerebral
pathology, because the lesion known as pachymeningitis
hæmorrhagica, often found in dementia paralytica, is considered by
some to be angiomatous; although by far the most generally
accepted view of this latter condition is that it is due to arterial
degeneration, and in part is an inflammatory exudate.

Syphilitic tumors, or gummata, are, like tubercle, a special

development with degeneration from the connective tissue, due to a
constitutional taint. This new growth is sometimes single, sometimes
multiple. The corpuscles of the neuroglia are the apparent points of
origin of the tumor, the substance of which is the firm, peculiarly
gummy, and non-juicy material from which the name is derived. It
would be impossible in our allowed space to trace this neoplasm
through the successive stages of its development. It has especial
clinical interest, inasmuch as it and its damage are probably
amenable to specific treatment when it has not progressed to too
great a destruction of brain-tissue.

The true cancers, or epithelial neoplasms, are not a common form of

tumor of either the brain or spinal cord. They present, as in other
parts of the body, a stroma forming alveolar spaces in which are
contained the nests of epithelial cells. These tumors thus present
characteristic differences in their histology from the connective-tissue
or mesoblastic groups, but clinically no very special interest attaches
to them. Their location, the rapidity of their growth, and their fatal
import are points which they share with most other new growths of
the cranial cavity.
The cholesteotomata, or pearl cancers, consist of hardened
epithelial cells which have undergone a sort of fatty degeneration.

The psammomata are loosely described as tumors containing sand-

like bodies, which bodies are normal about the pineal gland. These
sand-like bodies are found in tumors of some histological diversity,
and do not appear to have much identity of their own. They occur in
sarcomata and carcinomata, and are probably not to be
distinguished from mere calcareous infiltration and degeneration.
They are most common in sarcomata, as this is one of the most
common of cerebral tumors.

True osteomata—i.e. tumors with the structure of true bone—are

probably rare in the brain, although more common on the inner table
of the cranium; but the deposition of calcareous salts has been
recorded in a variety of conditions. F. X. Dercum, in a recent paper
read before the Philadelphia Pathological Society,34 has recorded the
autopsy of a paretic dement in which case calcareous deposits were
scattered throughout both hemispheres and the cerebellum. He
believes that “the areas in which the concretions were found were
probably foci of encephalitis of greater intensity than elsewhere. In
these foci inflammatory changes in the walls of the vessels became
pronounced; besides which the vessels increased enormously in
size and number; so marked is this increase that these foci could,
with perfect propriety, be called angiomata.” This is followed by
proliferation of the neuroglia, compression and destruction of nerve-
tissue, and deposit of the calcareous salts especially about and upon
the coats of the vessels. This case illustrates in the simplest manner
the formation of both vascular and sand tumors.
34 The Medical News, April 24, 1886, p. 460.

Pacchionian bodies are very common in the brain, and are really
small fibromata. They may form true tumors (Cornil and Ranvier)
capable of wearing away the bones of the cranium. In fact, even
when small they may have corresponding indentations in the skull.
They are not to be mistaken for tubercle. Clouston35 has described
excrescences from the white matter of the brain, growing through the
convolutions, projecting through the dura mater, and indenting the
inner table of the skull; which new growths he calls hernia of the
brain through the dura. We have not seen such a condition
described elsewhere, and think that we have here probably
Pacchionian bodies growing from the pia mater. They were found in
a case of tumor of the cerebellum.
35 Journ. Ment. Sci., xviii. p. 153.

A cystic formation, constituting a veritable tumor, not unfrequently

occurs in the pituitary body and mounts into the third and lateral
ventricles. Echinococci and hydatids also occur, and have the same
natural history as these parasitic offspring have when found in other
parts of the human body.

Obernier refers to an enchondrosis of the basilar process. Our table

presents one case of enchondroma.

Some of the gross appearances found on autopsies of tumors of the

brain are worthy of note. Often an area of congestion or
inflammation, especially of the membranes, is seen about the new
growth, and the brain-substance in its immediate vicinity is much
more frequently softened. The cerebro-spinal fluid is increased, and,
especially when direct pressure has been exerted upon the veins of
Galen, are found distended lateral ventricles. When a tumor does not
approach the surface, but has attained some size, the hemisphere in
which it is located often has a bulging appearance, crowding over
upon its neighbor, and the convolutions are flattened by the
pressure. The cranial nerve-trunks are occasionally involved in or
stretched by the tumor, and also occasionally the bones of the vault
or base of the cranium are extensively eroded. This happens
especially in cancer and osteo-sarcoma.

A few remarks should be made about the methods of making post-

mortem examinations and the gross appearances and conditions
likely to be found in brain-tumor cases. As not a few intracranial
tumors are connected with the bone or with the dura mater, the latter
being adherent to the skull-cap in some positions because of
inflammation arising from the seat of the growth, especial care
should be taken in removing the calvarium. Examination of the
external surface of the dura mater will sometimes reveal the
presence of a growth beneath or incorporated with this membrane.
The dura mater should not be roughly dragged from the surface of
the brain, but should be carefully removed by a process of partial
dissection. During this process a meningeal growth will sometimes
be found growing apparently from the fused membrane. In such
cases it is usually better to so proceed as not to entirely separate the
outer membrane from the growth. Indeed, this cannot be done
sometimes without injury directly to the specimen, and especially to
its cerebral surroundings. The dura mater having been removed, a
marked opacity, sometimes a dirty-brown hue shading off into a
lighter color, will indicate to the eye the probable presence of a tumor
beneath and growing from the pia mater of the cortex. In such a
case, and even when no such appearance is present, but a tumor is
suspected, the fingers passed carefully over the cerebral surface will
feel a hard, and it may be nodulated, mass at some position. A
growth, having been located in this way, should not be roughly
handled or at once examined by section. An effort should be made to
accurately localize it, not only with reference to lobes, but also with
reference to convolutions and fissures, and even special portions of
these. This is best done, after a thorough examination has been
made of the pia mater, by carefully stripping the pia mater from the
brain, beginning at points some distance from the growth and
gradually approaching it, and leaving the pia mater for a short
distance around the growth connected with it. The location having
been fixed and other portions of the brain having been examined, if it
is not possible or desirable to retain the entire brain as a specimen, a
block should be removed embracing a considerable portion of
healthy brain-tissue on all sides of the tumor. In order to study the
gross internal appearance of the tumor, it is a good plan to make a
clean section through the middle of the tumor. From each side of this
cut fragments can be taken for microscopical examination without
deranging appreciably the size and appearance of the tumor.
When the tumor is not meningeal or cortical, or not situated at the
base or floor of the skull, its presence may be revealed, when it is in
centrum ovale and of considerable size, by either hardness or
fluctuation of the hemisphere in which it is located, this fluctuation
not being due to the tumor itself so much as to the breakdown of
tissue around it. Large sections in known positions with reference to
convolutions and ganglia should be made when examined for tumors
deeply situated. If possible, sections close to and just before and
behind the growth should be made, so as to assist in the accurate
localization.

Small tumors are not infrequently overlooked by careless observers,

and even growths of considerable size have escaped discovery by
one examiner to be found by another. Tumors in certain special
localities, as between the temporo-occipital lobe and the superior
surface of the cerebellum in the great longitudinal fissure, or small
growths in the substance of the cerebellum or deep in the Sylvian
fissure, are more likely than others to be passed by, although this, of
course, is not likely to occur when the examination is made by a
competent or careful physician.

DIAGNOSIS.—The diagnosis of the existence of an intracranial tumor,

as a rule, is not difficult. It can be made with greater certainty than
that of almost any other serious encephalic disease.

It is sometimes important to decide as to the nature of an intracranial

neoplasm, particularly whether or not it is syphilitic. Little is to be
gained by following the plan adopted by some physicians, of treating
all cases as if they were due to syphilis, on the principle that these
are the only forms of tumor which can be reached by treatment. The
pitiable condition of such patients is sometimes thus made worse. In
every case careful and persistent efforts should be made to obtain
an authentic previous history from the patient. Whenever possible
the physician should search directly for the physical evidences of the
former existence of syphilis—for cicatrices on the genitals and
elsewhere, for nodes and depressions, for post-cervical and other
swellings, etc. A history of previous disease of the throat and of
pains in bones and nerves, of epileptiform attacks, of headache, and
eye symptoms which have disappeared under treatment, should be
sought out. It is not well to give too much credence to the stories of
patients, who are not always willing to admit their past lapses from
virtue; but, on the other hand, the plan of suspecting everybody who
presents advanced cerebral symptoms is often a grievous wrong.
Not infrequently external cranial nodes are present in cases of
intracranial syphilis.

Carcinomata and sarcomata, particularly the former, are

comparatively rapid in their progress. They sometimes involve the
bones of the skull, even to the extent of perforation.

The existence of an inherited tendency and of tuberculosis in other

organs, with the special phenomena of general tuberculosis, assists
in the diagnosis of tubercular tumors.

The frequent occurrence of gliomata in early life, and the

comparatively frequent absence of severe irritative symptoms, with
the well-preserved general nutrition of the patient, speak for these
growths.

Cerebral abscess is, on the whole, more difficult to diagnosticate

from intracranial tumor than any other affection. Abscess, however,
more frequently than tumor, can be traced directly to a traumatism. It
is often associated with disease of the internal ear. Obernier speaks
of the headache of cerebral abscess as slight, but this does not
correspond with usual experience. Headache, on the whole, may be
oftener absent or less agonizing in abscess than in tumor, but it is
frequently present, and sometimes of great severity. Its greater
mildness in a few cases is to be explained by the fact that abscess
does not produce so much pressure within the intracranial cavity,
and does not so frequently cause irritation of the branches of the
trigeminus in the dura. Undoubtedly, the symptoms of abscess often
remain for a long time comparatively latent, with then a sudden
outburst of violent symptoms. The course of brain tumor is more
uniformly and steadily progressive, and febrile phenomena, the
results of pyæmia, are of more frequent occurrence in abscess than
in tumor.

In old cases of tumor it is sometimes necessary to differentiate

between it and the results of various forms of apoplexy, such as
hemorrhage, thrombosis, and embolism. Cerebral hemorrhage,
embolism, or thrombosis leaves a condition of paralysis, sometimes
with, but usually without, accompanying spasm or convulsion, which
simulates closely the paralysis and other permanent conditions of
cases of tumor occurring in the same cerebral locality. In these
cases, in the first place, the history of the disease will throw
considerable light upon the diagnosis. In both hemorrhage and
embolism the history is usually one of a sudden attack without
special premonitory symptoms. Hemorrhage gives usually a
precedent history of diseased kidneys, hypertrophied heart, or
atheromatous blood-vessels, and occurs generally in advanced life;
embolism, a history of rheumatism and valvular disease of the heart,
occurring at any period of life, early or late. In brain tumor the
previous history is usually one of traumatism, of constitutional
infection, or of a special predisposing diathesis. Blows and falls upon
the head are common antecedents, or a history of syphilis,
tuberculosis, scrofula, or cancer is present. Tumor, like embolism
and unlike hemorrhage, may occur at any time of life. While slight or
dull headache, with more or less vertigo, may be present in cases of
hemorrhage and thrombosis, the severe and often agonizing
headache, with vomiting and serious vertiginous attacks, which
precedes the paralytic or other phenomena of tumor, is a much more
conclusive symptom in the latter cases than in the former. Choked
discs and optic neuritis are much more likely to occur in tumor than
in the other affections.

Brain tumor must sometimes be diagnosticated from the head

symptoms of some form of Bright's disease. A case not long since
presented itself to one of us with a history of having suffered at
frequent intervals for two years with headache of gradually
increasing severity. Dimness of vision and slight temporary œdema
of the feet, circumscribed and painful swellings along the lymphatics
of the thighs and legs, with some mental irritability, were other
marked symptoms. The patient had been attended by several
physicians of prominence, one of whom had diagnosticated tumor of
the brain. The violent, apparently agonizing headache, with the
diminution of vision, and the absence of marked symptoms indicating
other organic disease, made the diagnosis of a growth in some non-
excitable region of the cerebrum most probable. Examination of the
urine showed no albumen. Careful examination of the eye-ground
with the ophthalmoscope, however, revealed the appearances of
retinitis albuminurica. Under a treatment directed to the relief of
chronic nephritis the patient's headache and other symptoms
improved.

It must not be forgotten just here, however, that, on the one hand,
ophthalmoscopic appearances very similar to those of albuminuric
retinitis are sometimes present in rare cases of brain tumor, and also
in other constitutional disorders, such as leukæmia; and, on the
other hand, that, as stated by Norris,36 exceptional forms of
albuminuric retinitis have been reported where the only change seen
in the fundus oculi was pronounced choking of the disc.
36 Op. cit.

Intracranial tumors must be diagnosticated from meningitis in its

various forms. In children tubercular meningitis sometimes closely
simulates brain tumor. Tumors of the brain are comparatively rare in
children, but, as has already been shown, gliomata and other tumors
do sometimes occur in early life. The course of tubercular meningitis,
whether in children or in adults, differs from that of brain tumor. It is
more irregular in its method of advance, or if it shows the regularity
which is sometimes present, and which has led authors to subdivide
it into three more or less completely separable stages, the symptoms
of these stages do not correspond with any closeness to those of the
initial, middle, and terminal periods of brain tumor, as already given.
Headache is usually present in both affections, although the absence
of headache in some cases of gliomata in children must be here
borne in mind. When headache is present in tubercular meningitis, it