Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy.

  • Walker, A. Earl (Arthur Earl), 1907-1995.
Date:
[1934?]
Catalogue details

Licence: In copyright

Credit: Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy. Source: Wellcome Collection.

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    Reprinted from Brain, Vol. Ivii, Part 4, December, 1934. CONGENITAL DEBMAL SINUSES: A SOURCE OE SPINAL MENINGEAL INFECTION AND SUBDURAL ABSCESSES.1 BY A. EARL WALKER, M.D., AND PAUL C. BUOY, M.D. Congenital Dermal Sinuses. Sacral and coccygeal pilonidal cysts or sinuses are common congenital anomalies, but they rarely extend to involve the meninges or the spinal cord. In higher spinal segments, however, sinuses, histologically identical with those occurring in the sacral and coccygeal regions, are found reaching and even penetrating the dura mater. Such congenital malformations, forming an epithelial tube from the skin of the back to the coverings of the spinal cord, are a potential pathway for infection of the subdural and subarachnoid spaces. This source of meningeal infection has been almost completely overlooked in medical literature, and yet once recognized and the condition looked for such a mode of infection is not as rare as might be assumed from the lack of reported cases. Case 1.—L. I., a girl, aged 5, was referred to the University of Chicago Clinics from the Children’s Memorial Hospital, Chicago. From her birth the patient’s parents had noted a small dimple in the midline of the upper portion of the child’s back. In all other respects the child seemed perfectly normal At 6 months of age the site of the dimple became swollen, purple in colour and discharged a slightly bloody material. The patient at that time had a high fever and sore throat. Shortly afterwards she began to vomit frequently. A physician noted that the back w^as rigid and on lumbar puncture found 150 cells in the spinal fluid. After standing for an hour a pellicle formed in the fluid. A portion was injected into a guinea-pig and the animal died three weeks later. Examination of the animal is said to have revealed evidence of tuberculosis. Another observer saw the patient at that time and found her “ irritable and cranky.” The fontanelle was not bulging ; there was no strabismus and no Kernig’s sign, but there was definite rigidity of the neck. He thought the child was suffering from an encephalitis. Subsequently another specimen of spinal fluid was injected into a guinea-pig and again the animal died. This was considered conclusive proof that the child was suffering from tuberculous meningitis. 1 From the Division of Neurology and Neurosurgery, University of Chicago Clinics, Chigaco, Illinois.