Brain abcess : clinical and operative data / Charles Bagley.

  • Bagley, Charles, 1882-
Date:
1923
Catalogue details

Licence: In copyright

Credit: Brain abcess : clinical and operative data / Charles Bagley. Source: Wellcome Collection.

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    ‘‘Do you believe the diagnosis could have been made earlier?'’ is a usual question after all operations for brain abscess. The physician then looking back¬ ward is anxious to determine whether he has deprived the patient of a chance for recovery. In the light of operative findings, one is always forced to acknowledge that more attention should have been paid to certain symptoms observed during the few days or even weeks before admission to the hospital. It is often difficult, of course, to differentiate between symptoms of the primary inflammation and those due to the brain abscess. Fear of the presence of an abscess frequently prevents the physician from facing the extremely unpleasant situation until the appearance of grave symptoms. A headache after mastoid operation, for instance, is discounted until it becomes very trouble¬ some and associated with other evidence of intracranial involvement. The period between initial and advanced symptoms varies from a few days to several months, but in either case the operative procedure is likely to be postponed until demanded by the patient’s con¬ dition. In looking over our histories with abscesses second¬ ary to otitis media, mastoid and accessory nasal sinus inflammation, we find that the shortest interval between the initial symptom and the drainage of the abscess was three weeks. Case 1.—R. W., a girl, aged 15 years, had left otitis media beginning Dec. 1, 1913. The left mastoid was drained, Decem¬ ber 9. The condition was favorable until Jan. 7, 1914, when she had frontal and temporal headache, vomiting, and very severe dizziness and diplopia, and these symptoms were still present, January 27. The patient was stupid, and her general physical condition poor. There were ataxia of the left upper and lower extremity, and bilateral choked disk. There was no nystagmus. The temperature and pulse rate were slightly above normal. A left cerebellar hemisphere abscess was drained, January 28, but the patient died suddenly, forty-eight hours later. The course was short, but it is probable that there was a circumscribed collection of pus in the left hemi¬ sphere several days before operation, so that nothing was gained in waiting. If serious signs of compression had not appeared, the operative procedure would have been further postponed. Case 2.—E. B., a girl, aged 8 years, had severe pain in the left ear, Jan. 11, 1914. A paracentesis was done, January 21, but as the symptoms continued, the left mastoid was opened,