LISSAUER'S DEMENTIA PARALYTICA: CONTRIBUTION TO THE STUDY OF ITS DIAGNOSIS AND PATHOGENESIS.

Introduction CASES of general paralysis of the insane in which " focal " symptoms are a prominent feature, and which show circumscribed atrophy of parts of one or both cerebral hemispheres, have been grouped under the heading of Lissauer's Dementia Paralytica. Lissauer and Storch published their paper in 1901, but in Alzheimer's (1904) famous monograph there is mention of a number of cases of this condition which had been recorded prior to this. Since then further cases have been described. In 1932 Merritt and Springlova reviewed 35 cases previously published in the literature, and added eight cases which they had personally studied. In 1936 Ogino reported on three cases, and a year later Malamud's (1937) paper contained a description of four further cases. The latest studies on this subject by Dalke (1938) and Divry (1940) are unfortunately not available for comment in this paper. The definition of the clinical syndrome and the description of the pathological findings, in cases of Lissauer's Dementia Paralytica, given by Merritt and Springlova, represents the generally accepted view on the condition up to the present time. These authors came to the conclusion " that Lissauer's Dementia Paralytica should be suspected in every case of general paralysis with apoplectiform or unilateral convulsions, especially when these are followed by localizing signs, e.g. hemiplegia, aphasia, hemianopia, etc." The cardinal pathological feature, as previously indicated, is the presence of one or more areas of macroscopically apparent local atrophy, which are, with few exceptions, e.g. cases of Buder (1903) and Bielschowsky (1920) situated in the so-called " posterior " parts of the cortex. Indeed Alzheimer had already referred to the Lissauer type as general paralysis of the posterior cerebral cortex. Merritt and Springlova, and later Ogino, have regarded the distribution of the atrophic areas in most cases as being intimately related to that of the middle cerebral artery. The histological picture in the regions of the cortex which are not markedly atrophic is one of the usual G.P.I. process, often comparatively mild. On the other hand, the areas of local atrophy 22 coright.