Patient 9, a 25-year-old man, presented in June 1929 with suboccipital headaches associated with vomiting. The patient reported that in May 1929, while fatigued from a long car drive, he endured a severe suboccipital headache and vomiting. He also experienced seizures that consisted of neck retraction, dizziness, sweating, eye protrusion, and arm flexure. Cushing wrote that the patient was reportedly taken to the hospital in late May for “gastric symptoms.”[] On examination, the patient had a rigid neck, bilateral abducens palsy, bilateral Babinski reflex, hyperreflexia, and a choked disc of 4 diopters. Ventriculograms showed some evidence of obstructive hydrocephalus at the foramina of Monro and a filling defect of the third ventricle. He was given four radiation (X-ray) treatments and the pressure symptoms subsided for 1 year.\nIn 1931, his gastric symptoms returned, and a recurrence of the tumor was suspected. He received three additional radiation treatments, and the symptoms disappeared. However, the symptoms recurred again in January 1932. These symptoms were more indicative of a duodenal ulcer. He received radiation at the third ventricle, and he improved. However, several weeks later on March 3, barium studies confirmed the presence of a healed duodenal ulcer following the radiation therapy.[]
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.[]