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On the other hand, bilateral cortical affliction in the adult, in particular those affecting
the frontal lobe and parasagittal areas (gunshot injuries, parasagittal meningioma), may
produce, even in the absence of raised intra-cranial pressure, bladder dysfunctions which
are similar or identical to that of a young infant. Foerster (1936) found, following bilateral
destruction of the vesical cortical fields, firstly retention of micturition necessitating
catheterization, followed later by reflex micturition and incontinence which could last
for a considerable time. In patients with gunshot injuries of both paracentral lobes
during the First World War, he found that the bladder paralysis was combined with
isolated paralysis of both feet and toes. Fig. 138 shows the X-rays of one of my own
patients from the Second World War who sustained a brain injury of the upper parietal
region, resulting in a spastic paresis without sensory disturbances of the right arm and
particularly the right leg with paralysis of most of the dorsi- and plantarflexors of the
right foot and toes and, in addition, a marked spastic paresis of the dorsi- and plantar-
flexors of the left foot and toes. There was, therefore, no doubt that he had a bilateral
lesion of the paracentral lobe, more on the right than on the left. He was suffering from
extreme urgency and precipitous incontinence. Moreover, after micturition, urgency
returned after a few minutes and he passed again several ounces of urine. He died in 1965
from metastases of a carcinoma of the sigmoid colon. Recently, Andrew & Nathan (1964)
found that frontal lobe lesions caused frequency and extreme urgency of micturition
FIG. 138.
