Brain abcess / by Gilbert Horrax.

  • Gilbert Horrax
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: Brain abcess / by Gilbert Horrax. Source: Wellcome Collection.

    8/30 page 542
    Into this group fall the remaining 18 patients, and it is abscesses of this type which form the bulk of those in reported series, including that of Macewen. All of our patients in this class were operated upon, and all survivors have been followed from approximately one to six years, the majority from two years upward, so that there is little chance of any having a latent process which might again become active. Aetiology.—Two possible comments might be made concerning the sources of infection from which the brain abscesses in this group are derived. In the first place, the variety of antecedent infection was doubtless greater than that usually seen by otolaryngologists, although middle-ear complications were the largest single factor. In the second place, osteomyelitis of the skull or frontal sinusitis accom¬ panied by osteomyelitis accounted for one-third of the total number of abscesses. The following is a list of the aetiological factors : Otitis media and mastoiditis . . • . 4 Osteomyelitis of skull .. . • • • 3 Frontal sinusitis . . • • • • 3 Dental abscess . . • • • • 2 Scalp abscess . . • • 2 Nasal furuncle . . • • . . i Tonsillar infection . . . . • • 1 Upper respiratory infection . . . . i Unknown . . • • • • 1 Total . . . . 18 Mortality.—The total operative mortality in Group II was i6-6 per cent, as there were 3 deaths among the 18 patients during their stay in the hospital, which averaged about 8 to 10 weeks. Of those who died, two succumbed to meningitis following a spreading osteomyelitis of the skull. In the other the abscess was never found, a cerebral tap reaching the ventricle when the patient was in extremis. Thus, there were in reality but 2 deaths in 17 cases in which the abscess was treated, making the mortality 117 per cent. One patient died five months after leaving the hospital from a cause unrelated to his abscess. Five of the fourteen survivors have certain disabilities, as follows : Two have developed convulsions. One of these and two others have weakness of one arm and leg. The fifth patient has visual acuity reduced to reading large print, but gets along very well in school. METHODS OF TREATMENT It will be seen from the accompanying table (Table I) that, although a number of different procedures are listed, only three of these need be considered seriously— Table I.—Chronic Encapsulated Brain Abscess : Summary of Methods of Treatment and End-results Method No. of Cases Lived Died Marsupialization . . 9 8 I Tapping 4 4 O Extirpation with drainage 3 3 0 Drainage only 1 0 I Cerebral tap (abscess not found) 1 0 I 18 15 3
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