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.
6/18 page 46
![46 _ Symonds : Diagnosis and Localization of Cerebral Abscess commencement of headache had first suggested the presence of intracranial trouble. In neither case was any abscess found. Both ultimately recovered. The third case, also, with signs suggesting a left temporal abscess, was watched for some weeks and the patient recovered without operation. Adson offers no means of clinical distinction between what he calls the pseudo¬ brain abscess and the true. But the point of importance to be gained from these observations is that when the general and localizing signs of cerebral abscess are present a negative exploration does not necessarily mean an abscess missed. In such a case, therefore, it may be wise to await the possibility of spontaneous'cure before proceeding to a secondary exploratory operation. REFERENCES. [1] Richards, E. H., “A Case of Temporo-sphenoidal Abscess secondary to Otitis Media,” Guy's Hospital Reports, 1924, lxxiv, p. 109. [2] Symonds, C. P., and Ogilvie, W. H., “ A Case of Localized Suppurative Meningitis over the Motor Cortex,” Lancet, 1922, ii, p. 272 ; and Proc. Roy. Soc. Med., 1922, xv (Sect. Otol.), p. 39. [3] Adson, A. W., “Pseudo-brain Abscess,” Surgical Clinics of North America, 1924, iv, p. 503. Discussion.—Dr. Dan McKenzie (President) said that Dr. Symonds had raised many points of novelty and interest. He (the speaker) had always particularly emphasized the points referred to in connexion with cerebellar abscess. It was usually stated that cerebellar abscess was more frequently missed than was temporo-sphenoidal abscess. If true, this seemed difficult to account for ; he (Dr. McKenzie) wondered whether the point about nystagmus might not be one of the reasons. The books stated that in quite a large percentage of cases of cerebellar abscess no nystagmus was noticed. In some patients nystagmus was difficult to detect, but if the attention of a stuporose patient could be so directed that his eyes were turned towards the side of the lesion, a slow return to the neutral position would be noted, i.e., the slow component of the nystagmus was present, but not the quick one, because the stuporose condition prevented the operation of the higher nerve centres. Dr. Symonds’ reference to encephalitis was interesting, because cases were often seen in which there were symptoms apparently of brain abscess, which however was not found on exploration. Later on such patients nevertheless recovered. He (the speaker) had been called to see a boy who had a discharge from the ear, accompanied by headache and pain, and he had operated on the mastoid ; he did not feel justified at that time in exploring the brain. Two days later, however, it was insisted that he should do so. The patient was semi- comatose, and the temporo-sphenoidal lobe was explored but with a negative result. The boy recovered. There had recently been cases of encephalitis lethargica in which the symptoms had pointed to brain abscess. That diagnosis seemed to be confirmed if there was an ear discharge. With ordinary care there was no fear of harm from exploration of the brain. In testing the integrity of the naming centre, Dr. Symonds had suggested giving many test objects. He (the speaker) had been accustomed to test with only two or three common articles, but apparently there was safety in a greater number. These points seemed trivial perhaps, but it was the summation of apparently trivial points that might make all the difference in a diagnosis. Sir James Dundas-Grant said that Dr. Symonds’ insistence on the signs of superficial abscess was a valuable point; he (Sir James) could look back on some puzzling cases and he now realized that they had been of that nature. Mr. F. W. Watkyn-Thomas said he had had a patient in whom for a short time, there had been pure motor aphasia, with a lesion of Broca’s area on the left side. In this case nasal polypi had been removed, and the patient had come to the hospital having a fistula of the right frontal sinus and a superficial abscess. The right frontal sinus was opened and drained. The next day the patient had seemed well, but that night it was noticed that he “ was talking nonsense.” On the following morning he could say a few words, but they were unintelligible and disconnected. He could understand what was said to him, and could carry out suggested movements. There was right facial weakness, the tongue was protruded to the right, and](https://iiif.wellcomecollection.org/image/b30623868_0006.jp2/full/800%2C/0/default.jpg)
