Abcess of the brain / by Heinrich Neumann.

  • Neumann, Heinrich.
Date:
[1930?]
Catalogue details

Licence: In copyright

Credit: Abcess of the brain / by Heinrich Neumann. Source: Wellcome Collection.

    12/18 page 52
    in the case described, in the faint hope of getting some recovery of sight in the right eye, if it had not been that my colleagues expressed a desire to treat the boy by repeated lumbar punctures. This course of treatment was carried out. That no return of vision occurred in a case so advanced as this cannot be counted against the method employed, but the intracranial pressure, as measured by the spinal mano¬ meter, rose instead of falling, and this suggests that treatment by repeated lumbar punctures is not a satisfactory method in severe cases. The pressing need in this type of case is early diagnosis and, as the neurological signs are scanty, this depends on the employment of ophthalmoscopy in all cases of ear disease that show any signs of intracranial disturbance. The case described shows how it is possible for the condition to be overlooked through neglect of ophthalmoscopy. Even if the headaches and vomiting are severe in the early stages, they are always very much better at the time when the patient is going blind. Treatment, therefore, should be entirely governed by the state of the eyes. This condition of “ arachnoiditis ” comprises a part of that mixed group of cases known as “pseudo-brain abscess.” Mild cases of purulent pachymeningitis are probably also included in the same category. Conclusion.—Finally, diagnosis must be carried on during treatment. Operation should often be carried out in stages. There is a right and wrong time to operate in each case, and this can only be decided after accurate observation of the clinical condition. Additional symptoms often arise in the first few days after drainage of the abscess, due to oedema, to a slight degree of meningitis, or to faulty drainage of the abscess. Is the tube to be moved, or is it wiser to leave it undisturbed ? These and many other problems depend for their solution on careful day-to-day examina¬ tions. In my experience there is no disease in which repeated clinical investigations are so important as in abscess of the brain. Temporal Lobe Abscess. (Notes on seventeen consecutive cases operated upon at the Royal Infirmary, Edinburgh, from 1908 to 1929.) By J. S. Fraser, F.R.C.S.EcL, and B. B. Blomfield, F.R.C.S.Ed. In the first case, that of a female child aged five years, suffering from chronic middle-ear suppuration on the left side, the .temporal lobe abscess was complicated by a peri-sinus abscess, labyrinthitis and meningitis, which were all present on admission. The patient died. The second case was that of a male, aged 17 years, suffering from chronic middle-ear suppuration on both sides. The symptoms of brain abscess only came on after the radical mastoid operation had been performed on the left side ; a skin graft had been applied. It is noteworthy that the posterior wound healed well, and that the radical mastoid cavity and skin graft appeared satisfactory. Elevated temperature, headache and vomiting were followed by subnormal temperature and dilatation of the pupil on the same side, and twitchings of the opposite side of the body. After drainage there was retention of pus in the abscess ; this was relieved by improving the drainage. The patient’s mental condition changed with the development of the abscess ; from a shy, quiet youth he became violent and even maniacal. Recovery took place. In the third case, that of a female aged 11 years, suffering from chronic suppurative otitis media on both sides, with temporal lobe abscess on the left side, the drainage of the abscess was evidently insufficient, although a piece of brain was removed at the time of operation. Leakage occurred into the lateral ventricle, and thereafter meningitis developed. Death occurred only seventeen days after the onset of discharge of purulent cerebrospinal fluid from the abscess. In the fourth case, in a male aged 29 years, with chronic suppurative otitis media
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