Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds.

  • Symonds, C. P.
Date:
[between 1923 and 1940?]
Catalogue details

Licence: In copyright

Credit: Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds. Source: Wellcome Collection.

    2/18 (page 42)
    42 Symonds : Diagnosis and Localization of Cerebral Abscess week or so after the operation, is also of value. Of the additional information to be obtained from lumbar puncture I shall speak later. The localizing' signs of cerebral abscess may be considered under three headings : (l) cerebellar, (2) left temporal, (3) right temporal. (1) Of the signs of cerebellar abscess in the early stages suboccipital headache is of some importance, but in the later stages, when internal hydrocephalus is developing, the headache is commonly bifrontal or general. The abscess is usually situated deeply within the lateral lobe. Corresponding with this situation the symptoms are those of inco-ordination in the movements of the limbs on the same side, which is best shown in the upper limb. Disturbance of equilibrium and reeling gait are less common or later developments. The simplest method of examination is by the finger—nose—finger test. On the affected side there is deviation from the line of movement, and a tendency to under- or over-shoot the mark, giving a general impression of clumsiness. Of the other tests, one of the best is falling away of the affected limb when support is withdrawn by the observer from beneath the outstretched hands of the patient. The other sign of value is nystagmus. This is sometimes said to be absent by the otologist when its presence is recognized by the neurologist. The tendency of the eyes is to swing away from the side of the cerebellar lesion. This will show best when the patient is asked to look away from the direction of the spontaneous deviation, that is, towards the side of the lesion. If he is then asked to fix his gaze on the observer’s finger, the eyes gradually—it may be quite slowly—swing back towards the mid-line. This spontaneous movement the patient may or may not correct. If he does so the quick component is added and nystagmus results. If there is no attempt at voluntary correction, one cannot say that nystagmus is present, but one may speak of an unwillingness in conjugate deviation towards one side, which as a unilateral sign is of almost as great localizing value as the complete nystagmus. (2) In abscess of the left temporal lobe in a right-handed person the localizing sign of outstanding value is aphasia. If the abscess be situated far forward in the lobe it may not be present, but in the commoner site in the middle or posterior thirds it is an early sign, and easily elicited if the right method is employed. It is perhaps unnecessary at a meeting of this Section to emphasize the fact that a patient may be suffering from a definite aphasia and yet be able to converse without apparent difficulty and take part in the ordinary social life of a ward full of patients without the aphasia being discovered until the appropriate method of investigation is employed. For instance [l], a boy aged 16, who had been under observation in hospital for a week, was suspected of having a left-sided cerebral abscess. The house surgeon, who was a good observer, had written a full report in which he stated that there was no aphasia. He had rightly concluded on other grounds that an abscess was present. We made a collection of a dozen heterogeneous objects and asked the patient to name them. Books, matches, pen, watch and half-a-dozen others were named correctly. There were only two failures. When shown a key he could describe its use but could not name it. He rejected all substitutes and promptly accepted the word “key” as correct; so also with a plate. He said it was to eat off. and made of china, but could not name it. As before, he rejected substitutes and accepted the correct name when it was given to him. The abscess was found in the middle of the left temporal lobe and he made a complete recovery. The other signs of temporal lobe abscess are common to both sides. They are the only signs of a temporal abscess on the right side in a right-handed person. Of these there are three which are of practical value. The first is a slight weakness of the opposite side of the face, mostly of the lower half, which may be present when the patient talks or smiles, but is less apparent when he responds to the usual test of showing the teeth at command.