Congenital cysts of the fourth ventricle : a report of two cases associated with tumor of the optic thalamus and crus cerebri / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1904
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Licence: In copyright

Credit: Congenital cysts of the fourth ventricle : a report of two cases associated with tumor of the optic thalamus and crus cerebri / by J. Ramsay Hunt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    irregular outline, and fixed. Left pupil is normal in size, with sluggish reactions. Other cranial nerves are negative. Note, July 12, 1902. Emaciation is most extreme. The left hand and arm are in extreme flexion contracture, the hand resting on the acromion; left leg shows extension contracture. The left side of the body is cooler than the right. He hears and attempts to respond to some questions, but the response is inarticulate and indistinguishable. During the past four months there have been no paroxysms of forced laughter. He can tell the number of fingers held before either eye. The patient leads a purely vegetative existence; never speaks; sleeps most of the time; points to the mouth to indicate desire for food or drink. He recognizes members of the family and calls them by name. He drinks large quantities of water, and for three months has passed urine and feces in the bed, and if not watched will carry excrement to his mouth. The movements of the tongue and palate are slow and feeble, but there are no evidences of cranial nerve palsies other than those mentioned, with the exception of the motor portion of the right trigeminus nerve, the jaw deviating toward the right side. Pain impressions are equally keen on both sides of the body; no albumin or sugar in the urine. Autopsy Cadaver is in a state of extreme emaciation; sacral and trochanteric decubitus; tubercular focus in left apex; central pneumonic area in the left lower lobe. Chronic cystitis; otherwise the examination of the thoracic and abdominal contents was nega- tive. There was incomplete union of the osteoplastic flap at the site of the operation. The dura mater over this region is thickened and adherent and the inferior surface of the right temporal lobe shows old superficial foci of softening, with pial thickening. The sinuses of the dura and the vessels of Willis are normal; moderate internal hydrocephalus. Description of Crural Tumor and Cyst. Springing from the right crus cerebri is a firm, nodular, grayish-white mass filling up the interval between the cerebral peduncles. The outer side of the growth is in close relation with the right optic tract; the inner side encroaches on the third nerve. The right third nerve is compressed and atrophic. The basilar surface of the pons and medulla oblon- gata with their respective cranial nerves are normal in appearance. On splitting the cerebellum to afford inspection of the interior of the fourth ventricle, a cyst is disclosed springing from the anterior portion of its floor, to which it is firmly attached. (Fig. 5.) The posterior orifice of the aqueduct of Sylvius is free. The cyst is flattened and measures one and a quarter inches in its long and about five-eighths of an inch in its short diameter. The cyst wall is tough and dense and the surface is wrinkled. The interior is smooth and the only contents a clear fluid. The ependyma of the ventricle is dotted with numerous granulations. The cyst wall, at its attachment to the ventricular wall, dips down into the substance