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.

    12/44 (page 1654)
    / 1654 Proceedings of the Royal Society of Medicine 122 cavity can be thoroughly emptied by this method, and with the minimum of trauma to the brain (fig. 9). We have treated four cases by this method ; two cases, of staphylococcal abscess secondary to inconspicuous infection of the skin and subcutis, one case of streptococcal abscess probably secondary to temporal bone disease and one case of pneumococcal abscess. This last was the only case in which the patient did not recover, and at operation there were found indications that the infection was Fig. 9.—sketch of an osteoplastic operation for subcortical pneumococcal abscess of the right parietal lobe. The drainage-tube passes into the abscesscavity. In front of it and not connected with the abscess there is a focal area of pachy- and lepto-meningitis and here the dura is seen to be firmly adherent to the cortex. The patient died of diffuse pneumococcal infection of the leptomeninges and ventricles three weeks after the abscess was drained. not localized (fig. 9). The patient died of pneumococcal meningitis three weeks after the abscess was drained. None of the other cases in which the abscess was drained through an osteoplastic flap showed any clinical evidence of meningitis after operation in spite of the fact that in two of them at least there was obvious spread of infection through the field of operation. The following case is an example Case 4 : Staphylococcal abscess of right precentral gyrus.—I. W., a girl, aged 7, referred by Dr. A. G. Maitland-Jones, had a trivial cut on her right knee and a few weeks later suddenly began to have Jacksonian motor attacks in the left side of the face, violent frontal headaches and vomiting. Four weeks after the onset of these symptoms a right osteoplastic exploration was made and an abscess 3 cm. in diameter was found immediately beneath the surface of the lowest part of the precentral gyrus. The abscess was emptied by suction without any obvious contamination of the operative field, and the cavity was drained through a small incision in the temporal region, the original incision being closed. The pus from the abscess showed Staphylococcus aureus in films and cultures. One week after operation this patient developed S. aureus infection along the line of the scalp incision and continued to discharge pus from various points during the next six weeks (fig. 10). She never showed any signs of meningitis and her general condition throughout this time was quite satisfactory. 1 Since this paper was written another staphylococcal abscess has been successfully treated by the same method.