Contribution to the morbid anatomy and pathogenesis of chronic internal hydrocephalus / by Harold J. Stiles.

  • Stiles, Harold J. (Harold Jalland), 1863-1946.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Contribution to the morbid anatomy and pathogenesis of chronic internal hydrocephalus / by Harold J. Stiles. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    pressure of the intra-veiitricular fluid, which is so marked iu the infantile specimens.” I shall now pass to the description of the brain and its membranes in the two cases. In the post-mortem record of Dr. Carmichael’s case, it is stated that the dura and its blood sinuses were normal, and that there were no adhesions between it and the arachnoid. There was a considerable increase of arachnoid fluid at the base, and the arachno-pia was oedematous. In my own specimen, the dura, apart from being thin, was normal. The lower border of the falx was highly arched, and had dragged upwards the tentorium, so that on coronal section its two halves each formed a very obtuse angle with the falx (Fig. 5). The space thus left between the elevated tentorium and the upper surface of the cerebellum was occupied by a hernia-like diverticulnm from the lateral ventricles (Fig. 4, *), about which more will be said later on. The cranial blood sinuses, as a result of the stretching of the dura and of the pressure exerted upon them from without, presented a trian- gular and, in some cases, a chink-like outline, the latter being the condition of the straight sinus (Fig. 5, S.S.), which was otherwise normal. There were no adhesions between the dura and arachnoid. The arachno-pia was examined for signs of meningitis, but none could be detected. The sub- arachnoid space in the inter-peduncular region contained a sheet of ice of some thickness, separated from that in the third ventricle by its thin, membrane-like floor. In order that the cisterna cerebello-medullaris and the parts about the roof of the fourth ventricle might be examined, the block from which Fig. 4 was taken was carefully dissected by removing the neural arches of the upper cervical vertebrm, the spinal dura, and a portion of the middle lobe of the cerebellum. It was found that the sub-arachnoid space was here practically obliterated by the jamming of the cerebellum down upon the posterior surface of the medulla, and that a somewhat condensed and adherent membrane intervened between the two. The foramen of Magendie was evidently closed. Since Hilton (^) drew attention to the closure of this foramen in basal meningitis, it has been frequently VOL. IV.—34