Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds.

  • Symonds, C. P.
Date:
[between 1923 and 1940?]
Catalogue details

Licence: In copyright

Credit: Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds. Source: Wellcome Collection.

    11/18 (page 51)
    Section of Otology 51 or swelling. Temperature 97*6° F. Pulse 100. Respirations 24. The boy had not vomited ; there was no nystagmus. Reflexes normal. November 11, 1924.—Mastoid tenderness has gone. Still a little apathetic. Discharge from ear copious. No other physical signs. Temperature 97-4 F. Pulse 98. Respirations 24. Diagnosis :—Mastoiditis, extradural abscess. Operation:—Mastoid opened. Bone acellular, cholesteatoma found in antrum. Sinus exposed, healthy. Extradural pus, with offensive smell. Dura mater over middle fossa covered with granulations. Dura mater pulsating normally. Radical mastoid operation performed. In view of the offensive nature of the extradural pus, the dura mater of the middle fossa was incised, and the temporo-sphenoidal lobe explored. A large cortical temporo-sphenoidal abscess, containing 2 oz. of pus, was opened. This was washed out with saline solution, and drained with a rubber tube. Lumbar puncture performed at the time of operation : Fluid under some pressure ; 42 cells per c.mm.; culture sterile. Pus from abscess :—Streptococci, on film and culture. Uninterrupted recovery. Wound healed well. General condition good ; cheerful and well, but is a little more excitable than before the operation. Discharged December 12, 1924. Left Cerebellar Abscess. By T. H. Just, F.R.C.S. I. S., FEMALE, aged 5, was admitted to hospital on June 11, 1926. Discharge from the left ear. “Low spirits,” losing weight, and some headache. Had had acute otitis media May 28, 1926; left drum incised. Had made a good recovery ; but discharge had recommenced. On admission.—Temperature 97 • 8J F.; pulse 92 ; respirations 18. Lies quietly on back. Occasional sucking of teeth. Flexion at hips and knees. Answered rationally. No cry. Tongue moist, furred. Slight otorrhoea, left. Eyes, pupils dilated, symmetrical. Reaction to light; ? reaction to accommodation. Ocular movements good ; no strabismus. Fundi—edges of discs blurred. Be flexes present, and equal. Upper limbs normal, reflexes normal; no dysdiadokokinesis. Lower limbs—flexion at hip and knee, variable. Kernig’s sign present. Knee-jerks not obtained. No ankle clonus. June 16, 1926.—Lumbar puncture.—Fluid under slight pressure; cells 136, nearly all lymphocytes; globulin normal; reducing substance normal; albumin, a slight trace. Blood-count.—Red blood-cells 5,900,000 ; white blood-cells 14,400; hgemoglobin 80 per cent.; colour index 0*7. Eyes.—Well-marked papilloedema, right and left, of the type that is associated with cerebral tumour. (Report by Mr. Foster Moore.) Operation.—Mastoid opened up. Pus found. Dura mater over middle and posterior fossae exposed widely. Pus over posterior fossa of dura mater, which was injected and tense, though pulsating. Posterior fossa dura incised and cerebellum explored when a large cortical cerebellar abscess was immediately opened. The abscess cavity was washed out with saline and tube drained. Pus from abscess.—Film—short-chained Gram-positive cocci. Culture—sterile. June 17, 1926, 10 a.m.—General condition good. Complete blindness. Pupils widely dilated. 3 p.m., vision returned.