On optic neuritis in intracranial disease / by J. Hughlings Jackson.

  • John Hughlings Jackson
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: On optic neuritis in intracranial disease / by J. Hughlings Jackson. 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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    never lose siglit of the fact, that a patient with optic neuritis and other non-localising symptoms may die rapidly or suddenly of the brain disease which they signify. But, besides rapid or sudden death in patients acutely ill (which may not seem remarkable, although in the cases I allude to it was to me most unexpected), patients with optic neuritis who have, to superficial appearance, little the matter with them—those supposed to be bilious or hysterical—will die rapidly or suddenly. The most striking cases are those of patients who have no defect of sight with their optic neuritis; and in some of them I feel convinced the diag- nosis of intracranial disease could not be reasonably made without using the opthalmoscope. A man whom I thought to be hypochondrical until I looked into his eyes, who gave only a vague history of twitching of one lip, had double optic neuritis, with good vision. He seemed, superficially regarded, to have nothing the matter with him; he became suddenly apoplectic, with hemiplegia, and died. A woman who had double optic neuritis, with good vision and some other vague nervous symptom, got well, except that the neuritis remained. Vision being still good, she then had attacks of giddiness, in some of which she would fall. She, however, looked perfectly well, and yet died in a few minutes one night; the evening before she was out with her husband marketing. There was an inquest, but no necropsy. A patient with double optic neuritis is always in imminent danger, however well he may seem in general health. Again, after seeming complete recovery from severe intracranial symptoms, optic neuritis remaining, I have known death occur rapidly by convulsion from haemorr- hage from a vascular tumour. I have known a girl who got well except for amaurosis from optic atrophy after neuritis, who died in the night by haemorrhage from a cerebral tumour. Optic Neuritis * with Localising Symptoms.—Localising symptoms are of no rational value, perhaps of some empirical value, towards the diagnosis of gross organic disease. They point to position alone. It is impossible to go into this part of my subject except briefly. It is exceedingly complex. We are now supposing that, from what we have called the non-localising symptoms, we infer tumour.—I would first remark, however, that there may be no localising symptoms, indeed, no striking symptoms of any sort when there is a tumour, even a large one, in the cerebrum or cerebellum. ■* Only a fragment of what was written under this heading was read.
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