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 4, a 32-year-old woman, presented in November 1930 with stress, an enlarged heart, moderate arteriosclerosis, papilledema, and a significantly elevated blood pressure of 270/150. On admission, she reported a 5-month history of headache, dyspnea, palpitation, and indigestion. Eventually, the patient developed hydrothorax that was relieved by a tap. On January 7, 1931, she became comatose, febrile, and suffered convulsive seizures. She died on January 8 with a temperature of 104°. The autopsy reported “gastric mucosa was found to be intensely injected and to contain numerous, small stellate-shaped recent ulcerations… The mucosa of the duodenum was injected but without ulceration.”[] This patient had a hypertensive crisis that caused gastric ulceration, not due to surgical intervention.