Discussion on the diagnosis and treatment of abcess of the brain : opening papers.

Date:
[1934?]
Catalogue details

Licence: In copyright

Credit: Discussion on the diagnosis and treatment of abcess of the brain : opening papers. Source: Wellcome Collection.

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    Section of ©toiog? President—Mr. W. J. Harris DISCUSSION ON THE DIAGNOSIS AND TREATMENT OF ABSCESS/dF THE BRAIN \J Opening Papers: (I) Hugh Cairns, F.R.C.S., and Charles Donald, F.R.C.S. (II) Sydney Scott, F.R.C.S. O Ui CD (I) Mr. Hugh Cairns and Mr. Charles Donald : In opening this discussion on. abscess of the brain, we will first describe methods of operation and then analyse our own material, especially the failures. Thick-walled Chronic Abscess Abscesses of long duration usually have thick walls, 05 cm. or more in width. This group includes abscesses that for long periods have given rise to no symptoms, and abscesses which after one or more operations have continued to discharge through a sinus. Our experience shows that for these cases complete removal of the abscess and its wall is the only satisfactory treatment. Thick-walled chronic abscesses tend to be loculated or even multiple, and treatment by drainage alone will rarely result in collapse of the abscess sac. Moreover, the wall of the abscess will never be absorbed and will persist in the brain as a foreign body, which produces gliosis and is likely to result in further abscess formation at a later date. The first two cases provide examples of abscesses of this type, the one treated unsuccessfully by drainage, the other successfully by complete excision. 14 1 >- s CA2 cZD CO &_ »_ i o o CD Case 1.— Chronic abscess of right temporal lobe folloiving gunshot wound thirteen years before. Drainage of abscess and removal of foreign body. Progressive fungus cerebri. B. pyocyaneus meningitis. Death. Latent chronic abscess in right occipital lobe. History.—Gf. S., aged 34, referred by Mr. Charles Goulden, had been wounded in the right parietal region by a bursting shell in 1915. A piece of shell was taken out of his brain twenty-four hours later, and he returned to light duty within three months. In 1919 he began to have paroxysmal attacks of headache, and in 1921, generalized convulsions. From 1924 onwards visual hallucinations occurred. He came to the London Hospital in April 1928 because his vision had been failing during the previous nine weeks. Examination. He had severe bilateral papillcedema, and visual acuity was fo in the right eye and §— in the left eye. There was left homonymous hemianopia. Smell was lost at the right nostril. The abdominal reflexes were diminished on the left side, and the left plantar reflex was extensor. X-rays showed a foreign body in the right temporal lobe and an oval hole in the right parietal bone (fig. 1). Operations.—On April 4,1928 an abscess of the right temporal region was drained through a small incision. It lay at a depth of 2 cm. below the surface of the brain, and its capsule was so thick that a scalpel was needed to open it. The abscess was imperfectly exposed owing to great tension of the surrounding brain. Films of the pus showed staphylococci, but no organisms could be cultivated.