Tuberculous abcesses of the brain secondary to tuberculosis of the cæcum / Carl W. Rand.

  • Rand, Carl W. (Carl Wheeler), 1886-1972.
Date:
[1935], ©1935
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Licence: In copyright

Credit: Tuberculous abcesses of the brain secondary to tuberculosis of the cæcum / Carl W. Rand. Source: Wellcome Collection.

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    tubercles or tuberculomata of various sizes. In the center of these masses was an abscess mass 2^2 by 2 by ijA inches which contained “yellow¬ ish, turbid liquid within ragged cheesy walls.” These were in the right frontal lobe. The patholo¬ gist reports that the tumors in the boy’s brain showed only a few giant cells, the greater part of the mass being without any recognizable structure. Leontine (1929) reports the case of a 27 year old man with a far advanced pulmonary tuber¬ culosis. The sputum was positive, the lungs ex¬ tensively involved, a tuberculous colitis was present, and a tuberculous meningitis suspected. At autopsy a tuberculous area in the parietal bone, which had caused extensive erosion, was found. The brain presented a large caseous area of tuberculosis which was apparently not a true abscess although it was so described in the title of the article. Evans and Smith (1931) reported a case in a 14 year old girl who had an extensive scrofula of the neck of 8 years’ duration. This patient had daily convulsions of increasing severity for 3 weeks and a terminal hemiplegia. The spinal fluid examination, 2 months before death, showed a clear colorless fluid containing 9 cells—all of which were lymphocytes—trace of albumin and globulin, a negative Kahn reaction, and a delayed positive reaction in testing for sugar by Benedict’s method. Bacteriological examination and guinea- pig examinations were negative for tubercle bacilli. Another spinal fluid examination 3 weeks before death showed increased pressure, 8 cells, positive albumin and globulin, bacterio¬ logical examination was negative. Before death the child developed choking of the discs, mental torpor, and incoherence in speech. Autopsy showed a large abscess in the left frontal lobe which contained thick greenish pus, the examina¬ tion of which revealed “abundant tubercle bacilli with typical morphology.” There was no evidence of general meningitis. The pus was stained by Gram’s method but no organisms other than tubercle bacilli were found. The re¬ gion of the abscess was described as follows: “The outer layer of brain tissue showed prac¬ tically no important changes with the exception of slight oedema. Bordering upon the necrotic area, there was noted a circumferential prolifera¬ tion of connective tissue cells. There was like¬ wise noted a number of new capillaries lying among the fibroblasts. These young capillaries were congested. The central area was composed of necrotic tissue, leucocytes, and lymphocytes.” Among the cases mentioned, apparently that of Evans and Smith is the only one of an undis¬ puted tuberculous abscess. The gross illustration of their case is identical in appearance with ours. The process of formation is apparently the same as that of an ordinary pyogenic abscess. These authors found tubercle bacilli in large numbers in the pus, but did not try to identify them in the abscess wall. Such cases are not necessarily fatal, for Naffziger has cured one such case by drain¬ age. SUMMARY AND CONCLUSION A case of multiple tuberculous abscesses of the brain is reported. This is believed to represent a rare type of tuberculous reaction in nerve tissue. The usual granulomatous or tubercle formation is not present. The abscesses apparently are formed as any other pyogenic abscess of blood-borne origin are. These tuberculous abscesses, when present, almost invariably accompany some other chronic tuberculous process in the body such as scrofula, tuberculosis of the caecum or tuberculous mastoiditis. In the case here presented typical tubercle formation was present in the caecum, but was absent in the walls of the cerebral abscesses. BIBLIOGRAPHY 1. Adams, S. S. Tubercular abscess of the brain. Arch. Pediat., 1896, 13: 607-609. 2. Evans, G. F., and Smith, C. F. Tuberculous abscess of the brain. Am. Rev. Tuberc., 1931, 24: 292-299. 3. Finlay, D. W. A case of empyema with cerebral abscess. Lancet, 1886, 1: 298-300. 4. Fraenkel, A. Ueber den tuberculoesen Hirnabscess. Deutsche med. Wchnschr., 1887, 13: 373-376. 5. Gowers, W. R. A Manual of Diseases of the Nervous System. Diseases of Brain. Vol. 2: 443. Fondon: J. & A. Churchill, 1888. 6. Idem. A Manual of Diseases of the Nervous System. Diseases of Brain, Vol. 2: 476-477. Philadelphia: P. Blakiston’s Son & Co., 1898. 7. Hassin, G. B. Dementia and multiple tuberculous brain abscesses. Med. Rec., 1915, 88: 737-740. 8. Huguenin, G. Acute und chronische Entzuendungen des Gehirns und seiner Haeute, Ziemssen’s Handb. d. spec. Path, u Ther., 1878, 2: No. 1, 329-756. 9. Leontine, G. E. Tuberculous abscess of the brain with subdural erosion involving the parietal bone. U. S. Veteran’s Bureau Med. Bull., 1929, 5: 371-373. 10. MacEwen, William. Pyogenic Diseases of the Brain and Spinal Cord, p. 125. Glasgow: James Mac- Lehose and Sons, 1893. 11. Meyer, Rudolph. Zur Pathologie des Hirnabscesses. Dissertation, Zurich, 1867. 12. Naffziger, H. C. In a personal communication Naffziger stated to the author that he drained a tuberculous abscess of the cerebellum which was secondary to a chronic mastoiditis. The granula¬ tion tissue which formed in the drainage tract so closely resembled a tuberculous reaction that he had some of it removed and injected into a guinea pig. Later the animal died of tuberculosis, indicating that he was dealing with a tuberculous lesion. After a stormy course of many months his patient recov¬ ered.