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

Date:
[1938?]
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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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    Is umber 4 BRAIN ABSCESS be secondary to an infection that has subsided. This latter etiologic factor was found liy Evans as a doubtful source of infection in seven of the 17 cases in Group III. The relative incidence of a preceding infective process in these cases was: Sinus disease, 2 cases; earaches, 2 cases; severe quinsy five months before, i case; carbuncle 14 months before, i case; and pneumonia followed hy a pneuniococcic arthritis, i case. In ten cases he was unable to determine any causative factor. We have encountered, within a period of nine months, four cases of brain abscess of undetermined etiology. All of them were Operated upon and recovered. CASE REPORTS Case I.—E. S., female, age 20, was admitted to the Graduate Hospital, September 12, 1936, complaining- of pain in the head and neck, vomiting, and blurring of vision. Her mother died 18 years ago of tuberculosis ; other than that her family and past medical history were negative. There was no history of chronic cough, running ears, sinus in fection or any other infective process. About three months prior to admission she had had a tonsillectomy performed, under local anesthesia, without any untoward effects. Six weeks later she began to complain of headache and somewhat later of ^ diplopia, loss of vision and vomiting. During the few days preceding admission the pain in the head had become severe. On admission her temperature was 99-3°; pulse, 64; respira¬ tions, 22; blood pressure, 118/90. She was mentally clear, had some rigidity of the neck, a bilateral Kernig, a bilateral papilledema of about 3 to dD, a cut m the left temporal field, weakness of both external recti, more marked on the left than on the right, a paralysis of both seventh nerves, more marked on the right than on the left, and no significant changes in the extremities. The spinal fluid pressure was 350 Mm. of water, and the spinal fluid contained five lymphocytes. The lumbar puncture relieved the headache for two days, after which it recurred with greater severity. The temperature varied between normal and 99.0 F., the pulse varied between 64 and 100, and the blood pressure remained fairly constant. Uranalyses were negative. The blood picture showed a mild secondary anemia, 12,800 leukocytes, 88 per cent polymorphonuclears. The blood Wassermann was negative. The stools showed ova and segments of Taenia saginafa ; the patient’s father recalled that she had had a tapeworm many years before. Roentgenologic examination of the skull and the paranasal sinuses revealed no abnormalities. The lumbar puncture was repeated Sep¬ tember 18, 1937, and showed a pressure of over 700 Mm. of water, and the spinal fluid contained 15 cells, but was otherwise essentially negative. It was felt she had a space-taking lesion, but owing to the confusing neurologic signs, especially the presence of the bilateral sixth and seventh nerve paralyses and the marked increased intracranial pressure without any cerebellar symptoms, localiza¬ tion w'as difficult. . OixJrarton.—September ig, 1936, by Dr. F. C. Grant: A ventriculogram showe a mass lesion on the right side, probably in the frontoparietal lobe. Accordingly, a rigbt frontotemporal bone flap was reflected. The dura was extremely tense and upon its reflection the sylvian fissure was seen to be pushed up by a mass beneath the surface and within the substance of the tip of the right temporal lobe. A transcortical incision was made over the tumor, which was removed without rupture. It measured 314 x 4^5 cm. The patient made a rapid and uneventful convalescence. All neurologic signs dis- appeared and she has remained well to date. Pathologic E.rmm'na/ion.—Section, of the tumor revealed a capsule 0.5 cm. thick, filled with fibrinopurulent exudate. Microscopic examination of the capsule showed it to be composed of a stout fibrous stroma, in which many short gha fibrils were to be