Patient 10, a 10-year-old boy, presented with a 3-month history of ataxia and clumsiness, a 6-month history of dysarthria, and a 3-month history of suboccipital headaches and vomiting. Physical exam showed secondary optic atrophy, nystagmus, left facial nerve paresis, slurring of speech, and marked ataxia. Cushing suspected a cerebellar tumor. In surgery, there was a “protruding, bleeding, cavernous angioma which burst its way (through) the left cerebellar hemisphere as soon as an incision was made [through] the dura in spite of the ventricular puncture.”[] The patient's blood pressure fell rapidly. Postmortem examination of the mediastinum was performed on the operating room table following the patient's death. Cushing reported “the whole fatty contents of the mediastinum had been completely digested away leaving the aorta exposed, the plexus of sympathetic nerves free and naked as though they had been dissected out.”[] Cushing also wrote that a 1-inch slit was found in the esophagus, allowing gastric contents to “leak out.” He reported: “I cannot believe that the perforation in this child was due to anything else than a digestive ulcer of the esophagus… the dissection appearance of the structures in the mediastinum was much more likely to have been produced by a digestive process…”[] This patient was also mentioned in Cushing's paper, “Peptic ulcers and the interbrain,” in which he discussed 11 patients suffering from both intracranial and gastric lesions.[]
Patient 11, a 53-year-old man who presented in September 1930, reported working under stress, suffering emotional distress, and vomiting at work over a period of 6 months. Exam showed left hemiparesis, left homonymous hemianopsia, and impaired memory. Dr. Cushing took the patient to surgery to remove nodular meningioma in the right frontal lobe. Surgery was complicated by hemorrhage due to tearing of the anterior cerebral artery segments embedded in the tumor. This resulted in bilateral spastic paralysis. A nasal tube withdrew 50 cc of coffee-ground material with red blood cells evident on microscopy. 2 days after surgery, the patient's temperature dramatically rose to 107°, he “vomited a large amount of bloody fluid,”[] and died.\nOn postmortem examination, Dr. Schulz reported that in the stomach, there were “numerous flecks of the coffee-ground material suggesting changed blood.” Numerous ulcerations “very superficial and were found scattered… both in fundic and pyloric regions.”[] Microscopic exam did not show “evidence of the arterial or capillary disease or any noteworthy constriction of or thrombosis of the vessels,” unlike the previous cases.[]