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A COMPARISON OF THE ONSET AND CHARACTER OF THE APOPLEXY CAUSED BY CEREBRAL HEMORRHAGE AND BY VASCULAR OCCLUSION

WILLIAMS B. CADWALADER, M.D.
JAMA. 1914;LXII(18):1385-1389. doi:10.1001/jama.1914.02560430015007.
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INTRODUCTION  The differentiation during life between spontaneous intracerebral hemorrhage and cerebral softening consequent on vascular occlusion is notoriously uncertain. Nevertheless, it is generally admitted, whether correctly or incorrectly, that the mode of onset and character of the apoplectic attack may be sufficient to determine the nature of the underlying lesion.Thrombosis, like hemorrhage, is dependent on arteriosclerosis or syphilitic arteritis, though some cases of vascular occlusion can be ascribed to certain changes in the blood, as in pneumonia and typhoid fever. Without trauma healthy blood-vessels never rupture. This may account for the rarity of cerebral apoplexy in the lower animals. Dr. Herbert Fox, director of the pathologic laboratory at the Philadelphia Zoological Gardens, has informed me that he has never observed arteriosclerosis of the brain or its results—softening or hemorrhage—in a series of more than twenty-three hundred post-mortem examinations of a large variety of mammals, birds and reptiles.Disturbance of

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