PSYCHOSES

[125] A confusional state associated with infective endocarditis.-DAVID SHAW. Jour. of Ment. Sci., 1935, 81, 435. THIS case is interesting as showing the development of a confusional'state associated with infective endocarditis. In the light of the post-mortem findings, the extensive area of ulcerative endocarditis, the damage to the brain and widespread area of infarction, it appears highly probable that the patient's dulled mental state, her emotional instability and incontinence, were due to repeated small embolic heemorrhages in the frontal lobes and hemispheres generally, and possibly in the thalamus. It suggests, too, that the confusional states which sometimes occur in advanced cases of endocarditis (apart from septic endocarditis) might be explained on this physical basis of repeated embolic haemorrhages in the brain, not large enough or situated in the necessary position to cause the usual marked physical lesions of hemiplegia, etc., but sufficiently destructive to damage the associational paths subserving the higher centres of cerebration.