Brain abcess following frontal sinusitis / by W.O. Ott.

  • Ott, W. O. (William Oscar)
Date:
[1921?]
Catalogue details

Licence: In copyright

Credit: Brain abcess following frontal sinusitis / by W.O. Ott. Source: Wellcome Collection.

    1/4 (page 1)
    Reprint from SURGERY, GYNECOLOGY AND OBSTETRICS July, iQ2i, pages 72-73 BRAIN ABSCESS FOLLOWING FRONTAL SINUSITIS By W. O. OTT, M.D., Rochester, Minnesota Section on Neurologic Surgery, Mayo Clinic A CASE of brain abscess following fron¬ tal sinusitis, which is one of a series previously reported from the Mayo Clinic (1), is selected for this report, because it illustrates excellently the classical symp¬ toms of brain abscess and some of the prob¬ lems met with in the surgical treatment of the disease. Case 112525. The patient, a gid, aged 11, was examined in the clinic, November 6, 1919. Her ton¬ sils and adenoids had been removed 7 years before; otherwise she had been in normal health. October ip, 1919, she was taken on a 150-mile automobile ride, and the next day she developed a coryza, which lasted 6 days, and was followed by headache, fever, and vertigo. Ten days after the onset a swelling was noticed below the right eyelid; this extended to the side of the face and forehead. October 28 the patient had a temperature of 102°. The swelling and pain persisted and November 5 a physician made an incision over the right eyebrow, evacuating pus. Examination at the clinic revealed a large, smooth, fluctuating swelling over the forehead. Extreme cloudiness of the right frontal sinus, with some cloud¬ iness of the left antrum, was shown by the roent¬ genogram. The pupils were equal in size and normal in reaction, with slight hyperasmia of the discs. No pus was found in the nose. The frontal sinuses could not be probed. The neurological examination was practically negative except for a slight ptosis of both eyelids. November 8, the patient suddenly went into general convulsions, which lasted 3 hours. Following this she was unable to move the left arm and leg, and the left side of the face. The right side was normal. Jacksonian convulsions of the left leg supervened on the same day; ankle clonus was marked on the left, and slight on the right. The Kernig sign was positive; the neck was rigid. In the afternoon of the same day there was a marked Babinski reflex on the left with the left arm and leg rigid. The patient was stuporous for the next 36 hours, with persistent left spastic hemiparesis. November 7, 10, and 17, the leucocyte count was 23,600, 25,800, and 12,000 respectively. Left pare¬ sis persisted and the patient’s temperature varied from normal to ioo° until November 23, when it returned to normal and remained so until the opera¬ tion November 27, when a fluctuating mass in the frontal area was drained. The patient convalesced favorably except for a slight fever daily, with per¬ sistent weakness of the left side, until a second operation December 19. At this operation sequestra were removed from the right frontal bone. The dura was exposed at one point but not perforated. The wound was drained with a gauze wick. The patient improved rapidly and in a few days was allowed to go home under observation. January 8, the patient had several left Jacksonian convulsions. She was not unconscious during the attacks. The third operation was performed Jan¬ uary 19, 1920. Sequestra were removed from the frontal bone and the dura was exposed over the right frontal area about 1.5 inches above the orbit. Again convalescence was satisfactory. The oedema of the eyelid disappeared, and the paresis improved, so that there was only a slight left-sided weakness. The patient went home, and from January 24 until March 1 she felt quite well, but still had slight left¬ sided weakness. She was able to roller skate and play, but had days of malaise, with loss of appetite. About March 1 she began to grow worse; headache and bulging of the area of the skull defect appeared, with daily fever and pain over the right frontal area. March 19, the patient returned to the clinic. Examination at this time revealed choked discs of four diopters in both eyes and a slight weakness of the left side of the face, left arm, and left leg, with some exaggeration of the deep reflexes on the left. March 27, under ether, through the site in the frontal region where bone had been removed at the previous operation, the dura was exposed. On the insertion of a trocar and cannula, through the area which had become walled off by adhesions, into the right frontal lobe, an abscess was encountered about 2 inches below the surface under the outer part of this lobe. The walls of the abscess were firm; it con¬ tained about 3 ounces of pus. The abscess cavity was washed out with saline solution by inserting into it a small catheter attached to a syringe. Two rubber tubes made by cutting a No. 16 French male catheter were inserted into the cavity for drainage. The patient made a rapid recovery and was able to leave the hospital on the sixth day. She gained in weight and strength rapidly. The paresis dis¬ appeared quickly, and the choked discs constantly diminished. One tube drain was removed 3 weeks after operation, and the second tube was gradually shortened. May 2, after the second tube had been so shortened that it just reached the outer edge of the abscess cavity, the dressings slipped during the night and the tube fell out. During the following