Discussion on the diagnosis and treatment of abcess of the brain : opening papers.

Date:
[1934?]
Catalogue details

Licence: In copyright

Credit: Discussion on the diagnosis and treatment of abcess of the brain : opening papers. Source: Wellcome Collection.

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    114 The only satisfactory way of dealing with this case would have been to ciissect out the whole abscess, and to do this a wide osteoplastic exploration would have been necessary. Even if this had been done, it is likely that the latent abscess in the right occipital lobe would have been overlooked and would have become active later. From this case we learnt that it is futile to treat a chronic abscess with very thick walls by drainage, and accordingly, in the next case of this type exploration was made through an osteoplastic flap. Case 2.—Chronic abscess of right parietal lobe following gunshot wound nineteen years before. Complete removal. Recovery. History—A G., aged 47, referred by Dr. Henry Cohen, was first seen on February 5, 1934 In'1915 he had been wounded by a bullet which cut a groove m the right parietal bone but apparently did not perforate the brain. He was unconscious for a few moments only and was able to walk back to the dressing station. He was discharged from hospital six weeks later apparently well, though from that time onwards he considered that he was a little sluggish mentally. He returned to duty, but in 1921 he suffered for about a year from numbness of the left arm and leg and a strong tendency to deviate to the left when walking. The condition was diagnosed as peripheral neuritis and he was put on half pay. After several months the symptoms cleared up completely, except that from that time onwards he had numbness in the sole oi the left foot whenever he was tired. In the following year he began to have occasional generalized headaches, but these were only s lg t until 1930, when they became severe after stooping in the garden. In 1931 he had an attack of tingling in the left upper limb spreading to the left lower limb, which was followed by clonic movements of the left upper limb. The attack lasted five minutes and there was no loss of consciousness or any residual symptom. He continued living a fairly active life until November 1933, three months before admission, when he began to notice difficulty in seeing to the left while driving a car. Shortly after this the headaches changed in type,_ becoming frontal rather than generalized and worse on the right side, present on waking in the mornings, and much more violent and frequent. He began to lose control of his left hand . “ it did things on its own ” if he didn’t watch it, as for example putting his table-fork into his pocket. After he had put his matchbox away in his pocket he would still “ feel ” it in his hand for a long time. x\t other times he would find it difficult to put down an object held in his left hand : he would still be holding a cigarette case in his left hand when he wanted to use the hand for something else. At times, for no reason that he could discover, he would have his left fingers and thumb outstretched while walking about. This loss of control in the left upper limb was progressive and was accompanied by clumsiness of the left foot. He could walk quite well but the toes of the left foot caught in every rug and it was not easy for him to put his left leg into his trousers. When walking he had difficulty in readjusting his direction : he would walk from a room into a corridor and instead of turning right or left would go straight ahead into the opposite wall, as if his biam wasn’t working.” There was no difficulty in finding objects that were in his field of vision, nor any other evidence of visual disorientation. He described it as being unable to concentrate on the direction in which he should walk. Nine weeks before he was first seen he had a second Jacksonian attack exactly similar to the one three years before. Shortly after this there was temporary improvement in the functions of the left arm and leg, but this lasted only three days and soon his leg began to give way at times, and once he fell. He became mentally slower. Examination.—He was slow in answering questions, but otherwise his intelligence appeared normal. There was a groove in the posterior part of the right parietal bone with a depressed scar adherent to it. X-rays showed an irregular fragment of bone in the depths of this bony defect. The optic discs were swollen (right, 4d; left, 4*5 d). Visual acuity, Te_ [n each eye. Incomplete left homonymous hemianopia, more in the lower than in the upper quadrants. Slight ptosis of right upper eyelid. Slight weakness of the lower part of the face on the left side. The left upper limb was a little smaller than the right and was slightly weak at all joints. At times, when he was concentrating, the left upper limb would assume some unusual posture : for example, during fixation while his visual fields were being tested, his left forearm was flexed and his left hand was held rigidly outstretched in front of him against gravity for the duration of one series of tests. Tone was slightly increased in the left arm and leg. The