Tuberculous abcesses of the brain secondary to tuberculosis of the cæcum / Carl W. Rand.

  • Carl W. Rand
Date:
[1935], ©1935
Catalogue details

Licence: In copyright

Credit: Tuberculous abcesses of the brain secondary to tuberculosis of the cæcum / Carl W. Rand. Source: Wellcome Collection.

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    elongated spaces filled with red blood cells. In the margin of this tuberculous mass only an occasional gland can be made out. The characteristics of the abnormal tissue are typical fibroblasts, lymphocytes, plasma cells and giant cells forming typical tubercles or a more diffuse new formed tissue. “Diagnosis. Tuberculous abscess of the right frontal lobe.” It is difficult to find, in the literature, reports of proved tuberculous abscess of the brain. MacEwen (1893) discusses the possibility of abscess of the brain as a complication of tuber¬ cular disease of the middle and inner ear. He mentions the fact that there may be extensive tubercular destruction of the osseous walls, a condition which I believe is rarely seen today. When abscess occurs in such cases it is usually superficial, communicating with the middle ear often by minute passage through the granulation tissue. MacEwen states: ‘‘Instead of a distinct abscess in the midst of the cerebral tissues, a superficial cerebral ulceration is occasionally found in connection with tubercle of the middle ear, the pus from this ulceration being confined by the soldering of the meninges at the periphery of the ulceration to the base of the brain and the dura respectively. Such a purulent collection might thus appear as a localized cerebral abscess, the pus being retained between the brain which formed the dome, and the dura which formed the floor of the abscess cavity.” In his series of 25 brain abscesses there was no case of true tuber¬ culous abscess located in the substance of the brain. Oppenheim (1911) mentions the fact that “in rare cases the tubercle bacillus has been found in the internal wall of the granular tissue lining the abscess, and in the pus itself (A. Fraenkel).” He goes on to state that he himself has found the tubercle bacillus in such an abscess during operation. Reik (1910) reports a case of cerebral tuber¬ culosis following otitis media in a 3^ year old colored boy, which was probably not a true tuberculous abscess in the sense we have defined it. The case, the report of which is well illus¬ trated, shows the left temporosphenoidal lobe to be almost entirely involved in the process. The disease had extended from the middle ear, soli¬ tary tubercles being found in the dura at autopsy and large areas of tuberculous caseation being present in the temporal and parietal lobes. This caseation caused considerable destruction of both the gray and white matter, but was not sur¬ rounded by a true abscess wall. Schorstein, in the Schorstein lecture of 1909, comments upon the rarity of tuberculous cerebral abscess secondary to tuberculosis of the lungs. He cites Gowers (1888) as stating that cerebral abscess never occurs when true tuberculous cavi¬ ties are present in the lungs. However, this is not necessarily true, as Rudolph Meyer (1867) mentions one case of abscess of the brain with co¬ existing tuberculosis of the lungs. Again Finlay (1886) quotes a case of Dr. Hadden’s of tuber¬ culous pyopneumothorax with abscesses in the frontal and occipital lobes of the brain. Like¬ wise he mentions one case recorded by Huguenin (1878). Fraenkel’s case is again mentioned, and one recorded by Wernicke and Hahn where an abscess in the left occipital lobe was drained by trephining. The patient survived for 13 days and at postmortem examination tubercules were found about the abscess cavity. Fraenkel was of the opinion that there was a definite connection between the cerebral abscess and tuberculosis of the lung. Schorstein comments upon the fact of the very great infrequency of tuberculous cerebral abscess in association with pulmonary tuberculosis, calling attention to the relative frequency of brain abscess in connection with bronchiectasis: “Cerebral signs in tuberculosis of the lungs point almost invariably to tubercular meningitis. Cerebral signs in bronchiectasis mean in nearly every instance cerebral abscess.” In discussing the etiology of brain abscesses in general, Gowers (6) again (1898) states: “The last local cause (extremely rare) is a tubercular growth in the brain, which has been known to break down into a collection of pus. Other tubercular tumours and other evidence of tubercle are usually present, and indicate the origin of the abscess.” The tuberculous process which he de¬ scribes is the more common finding and is dif¬ ferent from the pathology which we are discussing. Hassin (1915) reports a case of multiple tuber¬ culous brain abscess associated with dementia. The abscesses, however, “had no capsules and were separated from the cortex by an area of seemingly normal white substance. The abscess cavities were filled with a pea-green to yellow colored pus of a very offensive odor.” Cultures and smears made from this pus were sterile; the diagnosis of tuberculous abscess being based upon the fact that the patient had “a chronic ulcerative and miliary tuberculosis of the lungs, combined with tuberculous osteomyelitis of sternum.” Adams (1896) under the title of “Tuberculous Abscess of the Brain” reports a case of a 10 year old colored boy who died of miliary tuberculosis. The right half of the brain contained many nodular masses which were probably miliary