Ulcers of the Digestive Tract in Association with Cerebral Lesions *

The association of lesions in the central nervous system with those occurring in the digestive tract is no new concept and for many years has been developed by clinicians, pathologists, and experimenters. The former, particularly, have emphasized the functional nervous disorders and their gastric sequelae in so-called stigmatized individuals. Of increasing importance, because of their greater definiteness and tangibility, have been the observations of concomitant cerebral and gastro-intestinal lesions at operation or at autopsy. It has been assumed that the cerebral lesions, which have been generally chronic or subacute in nature, have preceded the erosions, ulcerations, and malacia of the upper gastro-intestinal tract. These affections of the esophagus, stomach, and duodenum have been more acute in nature and have usually occurred at or just prior to exitus. Gradually, with the aid of experimentation, the particular part of the brain to whose injury the gastro-intestinal disorders could be attributed was narrowed down to the interbrain and its nuclei.2' 6 8 Cushing, in his monograph Peptic Ulcers and the Interbrain,3 awakened renewed interest in the clinical syndrome, but recent case reports' indicate that not always was the lesion localizable to the diencephalic gray matter. Frequently a diffuse intracranial process, such as a meningoencephalitis or a large neoplasm, obliterated interpretable boundaries. Even when the site of the lesion appeared more circumscript, as in a well-confined neoplasm or a focal hemorrhage, it was often far removed from the presumed crucial centers of the diencephalon. The latter were either not at all affected or only indirectly by increased pressure in the third ventricle. In some instances even compression or destruction of efferent parasympathetic and sympathetic pathways has been held responsible for the lesions in the alimentary tract. Nonetheless, most clues, experimental and otherwise, point to the diencephalon. It may be of little value therapeutically to know the precise localization of the brain lesion. Certainly in but very few instances