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.

    21/26 (page 417)
    ciated with evidence of meningeal irritation and infection due to infected material having passed down the sinuses to these tissues. Clark [1] has reported a case which seems similar to these, although there was at no time any evidence of meningeal infection, nor was the nature of the lesion confirmed at either operation or necropsy. Case 7.—L. N., female, aged 13 years. Her development was normal. It was noted that from birth the patient had a small depression in the median line between the 4th and 5th cervical spines out of which grew a small tuft of hair about half an inch in length. She lacked dexterity and speed in execut¬ ing delicate movements with her fingers and hands, but there was no atrophy or motor weakness except a slight deficiency in adduction, abduction, flexion and extensisn of the little and ring fingers of both hands. The remainder of the neurological examination was quite negative. Eoentgenograms showed no defect in the 4th or 5th cervical vertebra but a cleft in the arch of the 3rd. From the clinical description it is, of course, impossible to be certain of the exact nature of the lesion, but it is not unlikely that this is an example of the same malformation which has not yet become infected. A careful search of the literature has failed to reveal further examples of this congenital malformation. The similarity of all seven cases, and the evident mode of infection through the dermal sinus, is quite striking and merits recognition as a clinico-pathological entity. The fact that two of these cases presented a clinical resemblance to tuberculous meningitis is still greater reason for the consideration of this congenital anomaly in any chronic meningitis, particularly as opera¬ tion offers such an excellent result. The presence of the minute opening of the sinus in the skin, commonly referred to as a dimple, from which a discharge occurred at intervals, had been noted by the parents in all cases associated with meningeal irritation, before the patients were referred to a physician. This anomaly when accompanied by the typical history of fever, stiffness and tenderness of the back, neck rigidity, some degree of motor weakness in the lower extremities and the finding of a pleocytosis in the spinal fluid, should suffice to make possible the diagnosis of infected congenital dermal sinus extending to the spinal meninges. Association with spina bifida.—It will be noted that every case was associated with a defect in the posterior neural arch which could be demonstrated radiographically. However, the defect demonstrable in the second case is the normal state for the sacral vertebrae at this age and cannot be considered as having any association with the congenital