Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy.

  • Arthur Earl Walker
Date:
[1934?]
Catalogue details

Licence: In copyright

Credit: Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy. Source: Wellcome Collection.

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    This illness, with great irritability, evening fever, vomiting, loss of appetite and rigidity of the back, continued with varying degrees of intensity for about eighteen months when, for no apparent reason, the child recovered and remained perfectly well until 5 years of age. During the intervening three years, however, the mother had noticed an occasional discharge from the dimple of a few drops of milky material, which was at times blood stained. This occurred two or three times a year and on two occasions the skin surrounding the dimple became red and swollen. During November, 1932, the patient began to complain of pain in the neck and back, particularly at night. She was taken to the Children’s Memorial Hospital. Examination at that time showed a spasm of the left sterno¬ cleidomastoid muscle, a scoliosis of the upper thoracic vertebrae with the convexity to the right and a small, slightly elevated dimple just above the spine of the 5th thoracic vertebra. Both knee and ankle jerks were very lively and a bilateral, sustained ankle clonus was present. The right plantar reflex was extensor and the left flexor. Boentgenograms showed an incomplete fusion of the laminae of the 4th thoracic vertebra and a marked spinal curvature. After ten days in the hospital the patient’s condition improved greatly and she was discharged. During the following months she was examined at frequent intervals in the out-patient department of that hospital. Her gait became pro¬ gressively more spastic, the reflexes of the lower extremities more active, and at times local tenderness was present over the 4th and 5th thoracic vertebrae. Because of this steady progression of her condition, she was readmitted to the hospital on April 22, 1933, for lumbar puncture. The fluid was clear, under normal pressure, contained three lymphocytes and gave a negative reaction for globulin (Pandy). The Wassermann test on this fluid was negative. She was again treated in the out-patient department. Late in June the patient began to scratch and rub the ulnar surfaces of both hands and arms, presum¬ ably as a result of parsesthesiae. Due to this rubbing, it was noted on her next visit on July 3 that the ulnar surfaces of both forearms were red and inflamed. The findings on neurological examination at that time were essen¬ tially as they had been previously. Boentgenograms showed no change in the appearance of the thoracic vertebrae, or of the defect in the 4th vertebra. A lumbar puncture revealed a xanthochromic fluid under very low pressure, con¬ taining fifty red blood corpuscles and an increased quantity of globulin as tested by Pandy’s method. Queckenstedt’s test revealed a partial block in the spinal subarachnoid space. On July 18, 1933, she was admitted to Bobs Boberts Hospital of the University of Chicago Clinics for an exploratory laminectomy. However, she shortly developed measles, thus delaying the operation. On August 10, 1933, examination revealed the dimple previously noted just above the spine of the 5th thoracic vertebra. This was not tender, seemed freely movable on the underlying tissues and no discharge could be expressed from it. Neurological examination revealed no abnormality of any of the cranial nerves. The tendon reflexes of the upper extremity were normal ; those of the lower very brisk
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