A manual and atlas of medical ophthalmoscopy / by W.R. Gowers.

Date:
1890
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Licence: Public Domain Mark

Credit: A manual and atlas of medical ophthalmoscopy / by W.R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    recorded by Vircliow, and is described further on in the section on Softening of the Brain. Parinaud^ rehates a case of thrombosis of the central artery of the retina, followed by symptoms of cerebral softening, in a woman aged seventy- one, who was suddenly seized with dimness of vision in the left eye, accompanied by the appearance of green and yellow spots on a grey ground. A few days later there was a central scotoma with pronounced peripheral limitation of the field of vision, and loss of colour-sense. Ophthalmoscopieally the only change observed was a diminution in the calibre of both veins and arteries, followed ten days later by oedema of the retina with haemorrhages, and capillary congestion aroimd the macula. Three months later there was atrophy of the disc, and several branches of the central artery were fiHform and white. Subsequently she developed loss of memory, aphasia, and hallucinations. Priestley Smith^ has m^ged that arterial thrombosis is the lesion in many cases that are thought to be embolism. He regards, as its causes, heart-failure (either fi-om organic disease or other cause), spasm of the vessels or disease of their walls, and blood-states. The transient failure of sight in the opposite eye at the onset he ascribes to spasm of the retinal vessels. Embolism.—The central artery of the retina is not unfre- quently occluded by an embolus, and the occurrence is of much medical interest. Nowhere else can the phenomena of vascular occlusion be observed dimng Hfe. The accident is commonly the consequence of heart disease, and is sometimes the first thing which draws attention to the existence of the cardiac affection. It was so in the case of a girl who came under my observation suffering from sudden loss of sight m one eye. On examination she was found to have a loud, distinct presystolic murmur. There was no j)ievious liistory of rheumatic fever or scarlatina, and there were absolutely no symptoms pointing to cardiac disease beyond the affection of sight. Embolic infarction in other organs in many cases ^ Gaz. M&d. de Paris,'' 1882, p. 627. = Oplitli. Kov., vol. iii D