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

  • Edward Nettleship
Date:
[1882]
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Credit: On the value of eye-symptoms in the localisation of cerebral disease / by E. Nettleship. Source: Wellcome Collection.

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    much worse in one eye than the other. Passing from inflammation to primary atrophy of the optic nerve, we here also fail to gain much help in localising brain-disease. I believe that atrophy following pressure on the chiasma, whether by tumour or by fluid distension of the third ventricle, presents nothing pathognomonic, either in its course or appearances. I would like to ask here whether optic atrophy is often met with in chronic hydrocephalus, as is sometimes stated ? I do not remember ever making the diagnosis. It is certainly possible in some, though by no means in all, cases of atrophy not preceded by papillitis to distinguish between spinal atrophy (where the disc is often opaque and greyish, and the lamina cribrosa concealed), and atrophy secondary to injury, pressure, or destructive inflammation far above the eye, in which the lamina cribrosa is often exposed, the disc somewhat cupped, and its colour less grey than yellowish. But these differences are far from constant, and give no aid in the localisation of brain-disease. Nor is it always possible to say whether atrophy has been preceded by papillitis or not. In regard to the mode of failure of vision in optic atrophy, and its possible bearing on our present subject, the state of our knowledge leaves much to be desired. For example, colour-blindness does not seem to occur in any constant relation, either to loss of vision, or loss of visual field, in optic atrophy. Some cases have very recently been recorded, which seem to point to the consciousness of colour depending rather on special endowment of some part of the brain than on any differentiation of the retinal or optic neural structures. Three of these are cases of loss of colour-sense in one half of the field of vision with no loss of acuteness of sight in the affected part (Bjerrum,* Samel- sohn.f H. D. Noyes.J) Noyes's case presented partial optic atrophy with Argyll-Robertson pupil and shooting pains; in one eye there was high amblyopia, with almost complete colour-blindness ; in the other colour-blindness in one lateral half of the field only, acuteness of sight being normal over the whole field. But cases are not wanting which seem to show that colour-defect, even when limited to one half of the field, may be due to changes in the optic nerve : thus in the same paper, Noyes relates another case of hemiachromatopsia of the nasal half of each field, with glaucomatous cupping of the discs, the temporal halves of the fields, as in most cases of glaucoma, being normal; and I have myself recorded two cases of injury to the optic- nerve, in one of which colour-perception was enfeebled, whilst in the other, with about the same visual acuteness, it was perfect. (St. Thomas's Hospital Reports, xi, p. 113, Cases I and vn.) Steffan. (Grafe's Archives 27, 2, p. 11) has given a case of colour-blindness, with very slight defect of visual sharpness, following an attack of giddiness, in an old man; the sight became quite perfect, and colour- perception improved, but some defect for green remained as long as four years after the attack. This case, which has been a good deal quoted as proving a colour-centre, certainly deserves attention, though it is not convincing. Colour-blindness is nearly always very marked in optic atrophy associated with locomotor ataxy, yet it is probable that in these cases the changes begin at the ocular end of the nerve. It is clear, therefore, that failure of colour-perception, in its bearing on cerebral localisation, needs further study ; and the point is one towards the solution of which we, as specialists, ought to be able to con tribute. • Bierrum /fosftitah-Tidcndc R. 2, B. 8, p. 41 (referred to in a paper by Dr. Berry, Edinburgh Medical Journal, February 1882). i Samelsohn (of Cologne), Centralblatt fur Mrdicinischcn Wissenschaftcn. 1881. No. 47 (referred to in Knapp's Archivet of Ophthalmology, xi, 217). : Noy«s, Knapp's Archivet 0/Ophthalmplow, xi, 210, 1882.
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