Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds.
- Symonds, C. P.
- Date:
- [between 1923 and 1940?]
Licence: In copyright
Credit: Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds. Source: Wellcome Collection.
5/18 page 45
![Section of Otology 45 to me the most probable explanation of cases in which the signs of a cerebral abscess are at one time present but disappear without the evacuation of pus. I have had three such within my own experience. The first was that of a boy who had a right-sided otorrhoea and mastoiditis, for which an operation was performed. I was asked to see him two or three weeks later on account of headache and drowsiness. I found slight swelling of both optic discs, which was confirmed by an ophthalmologist, and some alteration of the reflexes on the left side of the body, suggesting a right temporal lobe lesion. An exploratory operation was performed but no abscess found. As the symptoms persisted a second operation was done ten days later. No abscess was found, but the boy subsequently made a complete recovery. The second case was that of a man with left-sided otitis admitted to hospital for head¬ ache and drowsiness. He was somewhat confused, was definitely aphasic and had a right homonymous hemianopia. He refused operation and was subsequently discharged from hospital, having completely lost his aphasia and hemianopia. Of the third and most recent case I have more detailed notes. A boy, aged 10, was admitted to hospital on September 11 on account of pain in and behind the right ear following an acute otitis media of one week’s duration. The temperature next day was 100° F. and there was persistent pain with much discharge from the ear. At operation, the same day, pus was found in the mastoid cells and a small collection compressing the lateral sinus which was, however, not thrombosed. The dura in the middle fossa was exposed but not incised. The wound was drained. Following the operation there was a swinging temperature up in the evening between 99° and 105° F. ; the pulse ranged from 90 to 120. Mentally he was noted by the sister in the ward to be odd, apathetic, not speaking unless snoken to, taking no interest in his toys. On the nineteenth day after the operation a doubtful extensor response was obtained from the left foot. About this time he began to complain of right frontal headache, chiefly on waking in the morning. This was occasionally associated with nausea. I first saw him on October 7, twenty-five days after the operation, and found a definite extensor plantar response on the left with diminished abdominal reflexes on the same side. I made the diagnosis of right temporal abscess and operation was performed the same day. The dura was opened and the brain explored without any abscess being discovered. Lumbar puncture at the time of operation gave a clear fluid apparently under increased pressure, containing no increase of cells or protein. Following this operation his condition remained much the same. The temperature and pulse-rate were still high, there was a good deal of complaint of headache, but, apart from this, apathy was the most noticeable feature. Six days after this second operation I found the physical signs unchanged, and in the light of my previous experiences I suggested that we might be dealing with a non-suppurative encephalitis. It was decided, therefore, that no further operation should be undertaken for the time being, but that he should be given full doses of hexamine. About October 16, that is, five weeks from the date of admission, he began to improve, temperature and pulse fell and headache was less ; he took a natural interest in his surround¬ ings. On October 29 he seemed normal and I could no longer obtain an extensor response from the left foot. He has since remained well. It is, of course, possible that an abscess may yet be present, but I am inclined to the opinion that my provisional diagnosis of non-suppurative encephalitis will prove correct. The point to which I want to draw attention in these three cases is that the encephalitis was in each, sufficiently well localized to cause physical signs resembling those of a cerebral abscess. All were diagnosed as such, and the only one of the three who escaped operation was he who refused it. I have been interested to find, in a recent report [3] from the Mayo Clinic, by A. W. Adson, an account of three similar cases. All three were in children whose symptoms developed after otitis media. The first had signs of a right temporal abscess, with papilloedema, and progressive left facial weakness. The second also had papilloedema, with aphasia, right homony¬ mous hemianopia, and right-sided weakness—the classical signs of a left temporal lesion. Both were explored, the first four, the second nine, weeks after the](https://iiif.wellcomecollection.org/image/b30623868_0005.jp2/full/800%2C/0/default.jpg)
