On tumors of the optic nerve / by H. Knapp.

  • Knapp, Herman, 1832-1911.
Date:
1877
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Licence: Public Domain Mark

Credit: On tumors of the optic nerve / by H. Knapp. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    ON TUMORS OF THE OPTIC NERVE. A VERY limited number of tumors of the optic nerve has hitherto been recorded. W. Goldzieher, in a very valuable paper on the subject, published in Graefe's Archiv fur Ophthalmologie, 1873, states that in modern medical literature he has found only six cases of the kind, to which he himself adds three others. I have found records of a few addi- tional capes, and have seen three myself, two having been under my own care and one under that of Dr. E. Gruening at the New York Ophthal- mic and Aural Institute. I shall give a brief sketch of some of these cases, in order to obtain the data necessary for a general description of the affection. Case L—(Described by A. von Graefe,iii his Archives, vol. x. part 1, p. 193 etc., 1864.) A farmer, set. 23, had first noticed, two years previously, diplopia and protrusion of his right eye. The exophthalmos increased steadily, but the diplopia subsequently disappeared from the sight of that eye becoming lost. No pain was felt until a few weeks before the patient was first seen, when secondary infiltration of the cornea set in. On examination, there was found exophthalmos of 9', in the direction of the orbital axis; the lids could not be closed; the mobility of the globe was restricted inward, but in other directions was free; the centre of motion coincided with that of the globe. Behind the globe, a soft, elastic tumor was felt; S. = 0. The retinal veins were tortuous and dilated, the arteries attenuated. The inner half of the optic disk was swollen, with abrupt, slightly overlapping borders, reddish, and concealing the bloodvessels; the outer half was level. Graefe diagnosticated a relatively benign, orbital tumor, probably of a fibro- sarcomatous nature. From the fact that the centre of rotation corresponded with the centre of the globe, he concluded that a stratum of loose connective tissue separated the tumor from the globe. The freedom of the outer half of the optic disk led him to the supposition that the blindness was not caused by compression, but by the immediate transition of the tumor to the nerve, or possibly by its origin in the nerve itself. The tumor being situated within the muscular funnel, and surrounding the optic nerve, its extirpation with preserva- tion of the eyeball, he said, could not be thought of. He enucleated the eyeball, slit the stratum of connective tissue in front of the morbid growth, laid the bluish-red looking tumor bare, and removed it without difBculty. The opera- tion was followed by alarming cerebral symptoms, intense headache and nausea; the pulse fell from 80 to 52 beats, and the temperature rose to 40° C. (104° F.), These symptoms subsided upon the appearance of an extensive suppuration in the wound. The patient recovered. The tumor, examined by Recklinghausen, was pear-shaped, a little larger than a pigeon's egg, partially soft and gelatinous, and partially fibrous. The bulk of tlie optic nerve lay as a compact cord on one side of the tumor, and was covered, together with the whole tumor, by a tough, fibrous capsule. The limit of the nerve which looked toward the tumor, was ill-defined. The fibres of the cord-like portion of the optic nerve were preserved in their whole course, the others entered the tumor and were lost in it. This condition was found