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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    When last seen on May 29, 1934, she was able to walk without assistance, although there was some external rotation and eversion of the foot. All move¬ ments of the foot and leg are now possible. She felt quite well and was very lively. Pathological examination (Plate XIII, fig. 4).—The skin containing the dimple visible on the surface and the subdural mass leading down from it were sectioned serially and stained with hsematoxylin and eosin, van Gieson’s acid picro-fuchsin and impregnated by Perdrau’s method. Sections of the skin revealed a normal surface epithelium, the basilar layer of which contains a brownish pigment. There were the usual papillae and in the dermis are found many hair follicles, sebaceous and sudorific glands, all apparently perfectly normal. In about the centre of the section is seen an invagination of the epidermis forming a narrow epithelial tube which passes downward into the deeper layers of the skin. The epithelial lining of this tube is very similar to the surface epithelium except that the pigmentation of the basal layer and the normal papillae are absent. There are a few fine hairs which project from the neighbouring dermal connective tissue through this epithelium into the tube. There are also a few sudorific and sebaceous glands connected with this tube. The lumen is filled with cornified, desquamated epithelial debris. In the connective tissue of the dermis immediately about the tube is a rather marked cellular infiltration. The cells are largely of the lymphocytic series. Sections of the subdural mass show the downward extension of this epithelial tube. It is similar to that near the orifice on the skin surface except that there are no hair follicles and no glands. Here again there are no papillae. The tube passes beneath the dura mater, which is continuous with the dense connective tissue sheath of the epithelial tube. The tube terminates a short distance beneath the dura mater, its lower end being open and its lumen communicating with an extensive subdural abscess (Plate XIV, fig. 5). The subdural abscess is composed of a mass of inflammatory cells of which about half are polymorphonuclear leucocytes and half lymphocytes. There are in addition a few endothelioid cells and a few multinucleated giant cells. These cells are enmeshed in a loose reticulin network. The abscess is intimately connected with the dura mater, strands of which pass into the inflammatory mass (Plate XIV, fig. 6). The remainder of the dura mater is infiltrated by small round cells which lie about the vessels and between the collagenous fibres. There is no epithelium within the abscess other than the extreme lower end of the epithelial tube mentioned above. This patient’s history was not unlike that of the first case. Both were diagnosed as tuberculous meningitis, and both had slowly pro¬ gressing signs and symptoms of spinal cord involvement with mild remissions. Neither had significant sensory changes either before or after operation. The dermal sinus in this case, as in the first, consisted of an epithelial tube surrounded by collagenous fibrous tissue. However, unlike the first case, it contained dermal appendages and the sinus could