Concerning a unique disease of the cerebral cortex

Abstract

A. reports a case which he observed in the Mental Asylum in Frankfurt a.M. and whose central nervous system was given to him for study by the director Mr. Sioli. Clinically, this case presented an unusual picture that did not fit any known disease, while anatomically it demonstrated a finding that was distinct from other known disease processes. A 51 year old woman showed as her first obvious symptom jealousy concerning her husband. Soon a very rapidly progressive impairment of memory became noticeable. She could no longer find her way around her apartment, moved objects to and fro and hid them. At times she believed someone wanted to kill her and began to scream loudly. In the Asylum, her behavior is characterized by a total helplessness. She is totally disoriented to place and time. Occasionally she complains that she is at a complete loss to understand all this. She greets the doctor like a visitor and asks to be excused for not being done with her housework, then screams loudly that the doctor wants to cut her, or she rejects him with intense indignation using phrases which indicate she is afraid that he wants to assault her sexually. Sometimes she is completely delirious, carrying around her bedclothes, calling for her husband and her daughter, and seeming to have auditory hallucinations. Often she screams with a horrible cry for many hours. Because of her inability to understand the situation, she begins screaming loudly as soon as one starts to examine her. Only with frequent repetition was it finally possible to determine anything. Her memory is greatly disturbed. If one shows her objects, she is able to name these correctly, but immediately afterward has forgotten everything. While reading, she skips from one line to another, reads phonetically or with a senseless intonation. While writing she repeats single syllables many times, skips others and quickly becomes distracted. While speaking, she often uses embarrassing phrases, single paraphasic expressions (milk-pourer instead of cup), sometimes becoming stuck and stopping. Some questions she seems not to hear. She no longer seems to know the use of certain objects. Her gait is undisturbed, she uses her hands equally well. Her patellar reflexes are present. The pupils react. Her radial artery is a bit hard, there is no enlargement of the heart impulse, and no proteins.