Brain abcess / by Gilbert Horrax.

  • Horrax, Gilbert, 1887-1957.
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: Brain abcess / by Gilbert Horrax. Source: Wellcome Collection.

    7/30 (page 541)
    hemiparesis. Examination showed an emaciated child with bilateral choked disks of 4 diopters, a bilateral abducens palsy, and a left hemiparesis and hemihypaesthesia. Her white blood- count was 22,000, red blood-count 3,200,000, and her haemoglobin was 60 per cent. Operation.—This was carried out immediately upon the date of her admission. A small burr opening was made in the bone over the right parietal region, a ventricular needle inserted, and 25 to 30 c.c. of thin yellow pus evacuated from an abscess at a depth of 3 cm. below the cortex. The patient was coughing up greenish pus, so her chest was tapped also. Five days later her cerebral abscess was again evacuated by the insertion of a needle, but she died the same day. Post-mortem Examination.—Necropsy confirmed the clinical findings of a brain abscess with meningitis ; bronchiectasis with lung abscess, empyema, and bronchopneumonia. Cultures from the pulmonary processes showed a non-haemolytic streptococcus. Comment.—There is little to say about such a case except to repeat that any form of intracranial operation under similar systemic conditions seems almost unwarranted. On the other hand, when confronted with the decision clinically, it is difficult to refuse at least some such simple attempt to save a life. The following record illustrates the second type of these hopeless cases, ^ although in many of this variety it may not at first be possible to diagnose multiple I lesions. Case 2—J. R. W. (P.B.B.H. Surgical No. 26599), a 40-year-old white male, was referred : by Dr. A. R. Gardner, of Lowell, Mass., on June 16, 1926. History.—The patient had had pleurisy followed by empyema in February, 1926, and this was complicated by osteomyelitis of the left femur three weeks before admission. Frontal headache and paralysis of the left arm and leg had developed six days prior to entrance, and he had had one convulsion three days previously. Neurological examination showed early choked disks with £ D elevation, and the left pupil was larger than the right. He had a left partial hemiplegia, paralysis being complete in the left arm. His deep reflexes were greater on the left than on the right, with a positive Babinski on the left. There was likewise a i hemihypaesthesia of the left side. Operations.—These consisted in three cerebral tappings, the first of which was carried out on June 22, 1926, over the right parietal region. A small abscess was reached at a depth j of 5 cm. below the cortex and 6 c.c. of thick pus evacuated. Pneumococci were disclosed by smear, but cultures were negative. Further taps were made at the same site on June 25 and July 3, the former being negative, the latter yielding 10 c.c. of pus. The patient died on July 8. Post-mortem Examination.—Necropsy disclosed seven scattered brain abscesses, six of them being in the cerebral hemispheres and one in the cerebellum. I CO O cc ZD o on G? m Q. 0 CO CO 'Tj Comment.—It could not be told from this patient’s examination that multiple abscesses were present; therefore, the operative procedures seem quite warranted. Certainly no more radical measures than repeated tappings could have been con¬ sidered with an abscess at so great a depth below the surface. Group II.—CHRONIC SINGLE ABSCESSES (USUALLY ENCAPSULATED) The second group is the one with which we are particularly concerned, as it represents the cases which are distinctly amenable to surgical therapy. The types of treatment are to be discussed, not only as to their technical features, but in connection with the clinical application or indication for one method or another, and a brief word as to the aetiology of the abscesses in this second group would