On the value of eye-symptoms in the localisation of cerebral disease / by E. Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1882]
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Licence: Public Domain Mark

Credit: On the value of eye-symptoms in the localisation of cerebral disease / by E. Nettleship. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    l Reprinted for the Author, with corrections, from the British Medical Journal, Dec. 2nd 1882.] THE VALUE OF EYE-SYMPTOMS IN THE ^L&CALISATION OF CEREBRAL DISEASE. Read in the Section of Ophthalmology at the Annual Meeting of the British Medical Association in Worcester, August 1882. By E. NETTLESHIP, F.R.C.S. Ophthalmic Surgeon to St. Thomas's Hospital. This subject, which might, I feel sure, have been much more appropriately introduced by a physican, presents itself to a specialist somewhat in the following form. How far can one, who is engaged in treating ophthalmic cases, con- tribute to the diagnosis of intracranial or intraspinal disease ? For my own part, on the present occasion, I propose to keep almost entirely to the question of intracranial disease, though I would by no means wish to see diseases of the spinal cord excluded from the discussion Whe- ther we include diseases of the cord or not, the whole subject naturally tails into two divisions, according as disturbances of vision and sensa- tion, or affections of ocular movement, cause the symptoms we have to examine ; and in each division, we must distinguish, as far as possible between eye-symptoms due directly to peripheral changes, and those caused by disease of the oculo-motor or visual centres. A. Visual and Oculo-Sensory Disturbances.—-It is 'not necessary to occupy much time in discussing double optic neuritis (papillitis): for double optic neuritis very seldom helps us to decide where a brain- lesion is ; and it lies beyond our present subject to ask what aid this condition gives us m deciding the nature of the disease. The occurrence of optic neuritis with meningitis points to the meningitis being basic • for it is, according to all observers, rare in meningitis of the convexity' In regard to tumour, it is worth asking whether papillitis occurs more commonly, or comes on earlier, when the tumour is at the base, or in the anterior part of the brain, than when it is situated in the cerebellum or posterior parts of the cerebrum. I do not know whether any statistics on this point exist; it is obviously a question on which the collection of good evidence would be full of difficulties.—Uniocular papillitis sometimes occurs in cases of coarse brain-disease, and has some local- ising value—generally coming on, so far as recorded cases tell, in the eye opposite to the lesion. It is of importance that all cases should be carefu ly observed and recorded; and it would be well to include, as possiblyi bearing on the subject, cases in which the papillitis, though eventually double takes place in one eye long before, or much more .severely than .n, the other; also cases of double and equal pnpiE alaIt kT* T f CCted in °-nC lye than the olher! 1 ^ve seen f;^f . * A' w.hlch a tumour ,n thc postcro-inferior part of the on the nght side of the face and head ; then she had simultaneous double