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Cerebral accident secondary to gunshot wounds in the neck are sufficiently rare in civil practice to warrant reporting a case. In military practice, cases are relatively less infrequent. George Makins, 1 temporarily surgeon general and consulting surgeon to the British forces, reported fourteen cases and reviewed them critically. Colledge and Dunn 2 reported four cases of hemiplegia caused by embolism in the carotid artery following gunshot wound which occurred in military practice; these reports included the autopsy observations. REPORT OF A CASE E. F., aged 24, a housewife, was examined eight weeks following a gunshot wound of the neck. She complained of difficulty with speech and in writing the names of some objects, even with the left hand. The injury occurred when an officer shot the patient from a distance of about 200 feet. She immediately became unconscious and was driven to a hospital, a distance of about a

Diazoxide given for hypertensive crises caused severe complications in two patients. Hypotension, anginal syndrome, cerebral ischemia, and right hemiplegia developed in one patient, and myocardial infarction in the other. ( JAMA 235:275-276, 1976)

To the Editor.— The usual signs and symptoms of acute cholecystitis have been well described.1The picture is one of a patient with pain in the right hypochondrium with associated vomiting and fever. The signs include tenderness with guarding and rigidity in the right hypochondrium, although fibrinous adhesions from the gallbladder to surrounding structures are common findings at the time of operation. A friction rub over the surface of the acutely inflamed gallbladder may not have been previously described.2The following case report illustrates this finding, not mentioned in standard texts. Report of a Case.— A 45-year-old white man with a history of aphasia and memory loss underwent an exploratory craniotomy, at which time a falx meningioma was removed through a left frontoparietal incision. The postoperative course was complicated by severe cerebral edema resulting in a marked expressive aphasia and dense right hemiplegia. Three weeks following surgery, the

To the Editor: —In 1943 I was stricken by coronary thrombosis followed by cerebral embolism, which resulted in right hemiplegia and complete aphasia. I was a shut-in within a paralyzed body and a shut-out from the world outside. It was then, by using my left hand, that I devised a code of communication, 21 hand signs. It was two and one-half years later, however, before I could express myself orally and tell an artist how to make the drawings that became the "Hand Talking Chart." I should like medical colleagues who have aphasic patients to have the chart if they wish. During the last seven years, the chart has been distributed nationally and internationally by the cooperation of editors of medical publications, and I have received hundreds of favorable reports on its use. Aphasic patients can communicate their basic needs and desires, thus dispelling their fears, helping them to a

History. —A. W., a man, aged 55, married, a brush maker, who was born in Austria, was admitted to the Montefiore Hospital on Feb. 6, 1930, with a right hemiplegia and aphasia. The family and past history was without significance. He had been suffering from an infection of the large toe on the right foot during July, 1929. In August, when the infection was beginning to clear up, he began to complain of daily spells of headache, dizziness and a feeling of nausea. Between August and September, he lost consciousness on three occasions. He would fall suddenly and would have to be picked up and brought home. Following these episodes the patient knew that he had been unconscious. He complained of dimness of vision, and black and white spots appeared before the eyes. There was no diplopia. One day in October he returned home from work, felt tired and went

To the Editor:— The picture on the cover of the Feb 28 issue ofThe Journal"Le Pied-Bot" interests me, as one who has specialized in cerebral palsy. I have long contended that this child did not represent a classical clubfoot, but illustrated more a right hemiplegia, in which the internal rotators and flexors were more spastic than the external rotators and extensors. Although I use the word "spastic," this could be a tension athetoid hemiplegia. The factors favoring the hemiplegia include the facial asymmetry and the tooth markings so frequently seen in the patient with congenital cerebral palsy. Although the child's expression is one of cheerfulness, it is not necessarily one of intelligence. There is a possibility of a mild microcephaly; certainly the frontal lobes are not large. The most compelling feature of all is the fashion in which he carries his right upper extremity, internally rotated, dropped at

I wish to make a brief record of a case of pulmonary tuberculosis with intercurrent hemiplegia of the right side and motor and sensory aphasia, with letter-blindness, but not word-blindness. The patient is a physician and a member of the faculty of a well-known institution. He is now 35 years of age; he had pneumonia sixteen years ago, and had a slight attack again two years ago. His tubercular infection is probably now of about four years' duration. At the beginning of the year 1899 both lungs were infiltrated; the right, generally consolidated. The fingers were clubbed. January, 2, 1899, he had a sudden paralysis involving the right face, arm and leg. It was apparently simultaneous throughout this distribution, and did not extend from one area to another. There was a short period of unconsciousness. I saw him the next day at the request of Dr. D. D. Stewart, of

In cases in which it is necessary for the neurosurgeon to remove portions of the premotor area of the brain, he must first assure himself that in so doing he will not render the patient aphasic. In right-handed persons the center for motor speech always is located in the posterior part of the third left frontal convolution, just in front of the motor center for the face. In congenitally left-handed persons the speech functions usually are located in the corresponding area in the right cerebral hemisphere. The more pronounced the left handedness, the more certain it is that the speech function is located on the right side. Persons who acquire left handedness as a result of the occurrence of right hemiplegia early in life also usually will acquire complete right cerebral dominance, with the speech function located on the right side. Occasionally, the neurosurgeon is confronted by the problem of

Recently, 2 striking cases of extreme unilateral vasomotor disturbance associated with cerebral lesions have been reported. In the first, reported by Bucy, 1 there developed sudden right hemiplegia and hemianesthesia and aphasia, with absence of the radial pulse and unobtainable blood pressure in the right arm, thirteen days after a mild injury to the head. The right radial pulse first became palpable four hours after the cerebral accident. The blood pressure was first definitely obtained on the right side four days later and remained lower than that on the left for two additional days. The skin was "colder" on the right side for three days after the cerebral accident. All neurologic symptoms rapidly disappeared, and recovery was complete. The second case was reported by Kerr and Underwood. 2 After acute right hemiplegia with motor aphasia ten years prior to examination, there developed coldness of the right extremities, variable weakness or