Brain abcess of undetermined etiology : report of four cases with recovery / Joseph C. Yaskin [and others].

Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: Brain abcess of undetermined etiology : report of four cases with recovery / Joseph C. Yaskin [and others]. Source: Wellcome Collection.

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    April. 1938 thought that they were solid tumors. In Case 4 the lesion was also encap¬ sulated. In Case 3 there was no encapsulation, and this may be regarded as the only acute abscess in tliis series. The analysis of the clinical manifestations (Table il) suggests some diagnostic criteria. In all of the four cases there were evidences of increased intracranial pressure. In three cases there was marked increase in intraspinal pressure while no lumbar puncture was performed in the fourth case. Two of the cases showed marked choking of the disks, while the other two showed only slight blurring of the disk margins. The pulse was slow in all four cases which contrasts markedly with the normal or nearly normal temperatures. These evidences of increased intracranial pressure are more diagnostic of brain tumor than brain abscess. Flowever, the slow pulse rate has long been known to be suggestive of a brain abscess (Gowers,® Oppenheim,'^ Bailey®). In addition to the slow pulse the excruciating headache, observed in all four cases, was more suggestive of an acute meningitis than of a brain tumor. The evidences pointing to the existence of infection were meager: The temperature was normal or nearly so in all cases. The leukocyte count was slightly increased in two cases and normal in the other two. In only one in¬ stance was there a marked increase of cells in the spinal fluid. The localizing symptoms were no clearer than in the average case of brain tumor and ventriculography was needed in two cases in order to definitely localize the lesion. However, the pain in the head was definitely ipsilateral with the lesion in one case and more marked on the side of the abscess in two other cases. From personal observation of a considerable number of intracranial space¬ taking lesions and from a study of these four cases, it appears that the com¬ bined occurrence of severe, especially unilateral, headache, a persistent slow pulse, and some evidences of increased intracranial pressure should suggest, even in the absence of any evidence of infection in the nervous system or else¬ where in the body, the existence of a brain abscess. The suspicion of an ab¬ scess may then be followed by exploration, and since 50 per cent of these abscesses are solitary, timely and appropriate operative procedures will result in a greater number of recoveries. In the present series the first three cases may be regarded as having made a full recovery, while the fourth is still con¬ valescing. Summary.—Four cases of solitary cerebral abscesses of undetermined etiology are reported. All the cases recovered following operation. In two cases the abscesses were so heavily encapsulated that they were removed en masse at operation as it was thought that they were solid tumors. CONCLUSIONS From the study of these cases, it is submitted that the combined occurrence of severe, especially unilateral headaches, a persistent slow pulse, and evi¬ dences of increased intracranial pressure should suggest, even in the absence of evidences of infection in the nervous system or elsewhere in the body,