Volume 1

A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel.

  • Rosenthal, Moriz, 1833-1889.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on the diseases of the nervous system / by M. Rosenthal ; with a preface by Professor Charcot ; translated from the author's revised and enlarged edition by L. Putzel. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    b. Internal Pachymeningitis. This process and its sequences were not unknown to our predecessors (Baillarg-er, Pons, Oesterlen, etc.). The pathog-enic relations of the san< g-uinolent effusions and false membranes found between the dura mater and arachnoid, were often wrongly interpreted, and Virchow first thor- oughly recognized their anatomical character (Wuerz. Verh., Bd. VII., 1857). Pathological Anatomy. The internal surface of the dura mater is covered with a yellowish exudation, and strewn with ecchymoses; or a thin layer of dense fibrin is present which, with care, may be separated from the underlying membrane. At a later period, a very thin fibrous membrane, abundantly supplied with capillaries, forms at these spots, either on one or both sides of the brain, and especially at the convexity. In consequence of the duration and ex- tent of the inflammation, numerous layers (10-20) are superimposed upon the false membrane. Delicate blood-vessels develop in large-meshed plex- uses, which often rupture and give rise to haemorrhages either between the layers of false membrane or between the latter and the dura mater (hiiemorrhagic pachymeningitis of Virchow). These hremorrhages, which vary in volume, being more profuse at the centre and thinning off at the edges, are united into circumscribed foyers (simple or circumscribed) which adhere more or less firmly to the adjacent dura mater and arachnoid, and constitute Virchow's hiiematoma of the dura mater. These rounded cysts contain blood or serous fluid in varying proportions, and are found especially at the convexity of the hemispheres; more frequently in the anterior and middle regions than posteriorly, and sometimes in the cere- bral fossre. The hjeraatoma occupies either one or both sides, and causes cerebral compression. This prolonged compression leads to partial atro- phy, softening and discoloration of the cortex, with thickening of the meninges. Etiology. Pachymeningitis is nearly always chronic and is usually found in old age. The male sex is more predisposed to its development than the fe- male. Kremiansky (Virch. Archiv, B. XLII. pp. 129-321,1868) and Neu- mann have shown, by experiments on dogs, that pachymeningitis may be produced artificially by chronic alcohol poisoning, in consequence of pro- longed congestion and dilatation of the arteries. In man, also, chronic alcoholism furnishes the majority of cases of spontaneous pachymeningitis, and, according to Kremiansky, the process is usually situated at the vertex. Injuries to the dura mater, caries and degenerations of neighboring parts are also causes of secondary pachymeningitis. It may complicate re- current fever (Kremiansky), typhoid and typhus fevers, pleuro-pneumonia (especially during pregnancy), acute articular rheumatism, febrile exanthe- mata and puerperal diseases. It also occurs in the last stages of chronic diseases, such as tuberculosis, organic cardiac affections, diseases of the heart, diseases of the brain in the infant, and general paralysis of the insane.