The neuritic form of albuminuric retinitis / by Arthur J. Ballantyne.

  • Ballantyne, Arthur J.
Date:
[1905]
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Credit: The neuritic form of albuminuric retinitis / by Arthur J. Ballantyne. Source: Wellcome Collection.

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    is seen, both ophthalmoscopically and microscopically, to be limited to the actual nerve-head. (3) The retention of good vision. (4) The apparent tendency of the swelling of the disc to diminish when free diuresis was established, relieving the mental symptoms, and presumably causing diminution of intracranial pressure. It is to be noted that cases presenting this ophthalmoscopic picture, have usually shown an ex- aggeration of mental or cerebral symptoms, thus exhibiting a group of symptoms suggestive of intracranial tumour. One is tempted to think that the oedema of the nerve may have its origin in a rise of intracranial pressure, due perhaps to excess of fluid in the lateral ventricles of the brain. In the case reported above, such improvement as resulted from the onset of diuresis might be attributed entirely to relief of such excess pressure. It certainly was due to no improvement in the general health of the patient, who died, it will be remem- bered, three days later with no new development of pressure signs. Speaking of the class of cases in which the neuritic form of albuminuric retinitis occurs, Gowers states that it practically always occurs in cases of advanced chronic kidney disease, commonly of contracted kidney, but he mentions its occur- rence in a case of large pale kidney with commencing indura- tion. The above case was, so far as can be judged, one of chronic interstitial nephritis in a not very advanced stage, complicated by the supervention of an acute process. From a study of the foregoing in relation to other recorded cases, the following conclusions may be drawn :— (1) The neuritic form of albuminuric retinitis is of rare occurrence. (2) It is found usually in cases presenting severe cerebral symptoms, and may thus lead to suspicion of cerebral tumour. Renal disease must therefore be excluded, before resortmgto a diagnosis of cerebral tumour in such cases. (3) It is probable that in most cases other slight retmal changes are to be found at some time or other, which would point to the renal origin of the condition. (4) It occurs mainly in cases of advanced chronic inter- stitial nephritis, but may also accompany other, apparently less advanced, forms of renal disease. (5) The condition of the nerve is probably of the same nature as the choked disc of intracranial disease, and like it is to be attributed to increase of intracranial pressure. (6) Its occurrence suggests a grave prognosis, and is usually soon followed by a fatal result. REFERENCES. Gowers.—Medical OpMhalviomopy. Norris and OVwer.— Tcvt-hook of Dhcases of the Eye. _ Vol. III., p. 520- Cxoenoww.— (iraefe-Savmiscli llandhvch. Bd. XI., Kap.XXII.