Remarks on ocular symptoms in cerebrospinal meningitis : notes based on the examination of 73 cases / by Arthur J. Ballantyne.

  • Ballantyne, Arthur J.
Date:
[1907]
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Credit: Remarks on ocular symptoms in cerebrospinal meningitis : notes based on the examination of 73 cases / by Arthur J. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    occurred with perfectly steady fixation durinp indirect ophthalmoscopic examination. In the middle of auch an examination the pupil, which had been widely dilated, would suddenly and unexpectedly contract, and after an interval of seconds or minutes dilatation would occur again just as unexpectedly. This symptom, however, is not peculiar to cerebro spinal meningitia. The writer haa seen it in several cases proved by post mortem examination to have b^en tuberculous. Pupil Rkflbxes. The light rejlex was normal, or nearly eo, in 24 cases, deficient as regards speed or amplitude or both in 26, absent in 7, and variable in its activity in 11. The contraction of the pupil in near vision was good in 21, deficient in 15, absent in 7, and variable in 2, In 5 of the cases with deficient or absent reflex there was a correeponding deficiency of the faculty of convergence, which would account for the defect. The test for the convergence reflex could not be quite satisfactory, the results depend so much npDn the visual acuity and the mental condition of the patient. It was sometimes found, for instance, that while a child manifested no convergence or pupil contraction on being asked i& fix the finger tip or handle of the ophthalmoscope, these reflexes were immediately elicited by a more interesting fixation subject, such as a penny. The cilio-spinal reflex was present eighteen times and absent fourteen times. The orbici ]aris refiex was present five times and absent seven times. The pupil changes described by Squires'found in cases of basal meningitis (contraction when the head is flexed and dilatation when it is ext aded) were looked for in 3 cases, but not found. Total absence of pupil refiexes with contracted (2 mm.) pupils was observed in 1 case on the day of death. In some cases the activity of the reflexes varied in the course of the examination without obvious cause. In 1 ■case Oheyne-Stokes respiration was present at the time of examination, but no pupil changes were found to corre- apond with the different phases of the respiration. None of the pupillary phenomena, with the exception of total absence of the reflexes, seemed to be of any value as regards diagnosis or prognosis. Accommodation. It was only possible to test the accommodation in 7 cases, and in none of them was it defective. Strabismus. Strabismus was found in 15 cases. Eight others had a history of squinting or diplopia, either before oi- after admission to hospital.