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.

    18/44 (page 1660)
    observed in the basal cisterns at necropsy in other cases, where death has been caused by rise of intracranial pressure rather than by generalized meningitis. This explanation is in accord with our more recent observations on the occurrence of slight lepto-meningitis after an abscess has been drained. Incomplete drainage.—In the more severe infections incomplete drainage of an abscess may prove fatal, but that it is not always so is shown by the following case:— Case 8.—Bronchopneumonia. Local osteomyelitis and extradural abscess of right parietal region. Subcortical abscess of left parietal lobe (cultures sterile). Three operations for drainage of brain abscess. Recovery.—A. B., a male aged 28, referred by Dr. Robert Hutchison, fell ill with bronchopneumonia on December 15, 1928. December 28 : An abscess developed on the sole of the right foot and was opened. The pus was sterile on culture, but films showed Gram-positive cocci. January 5, 1929 : An abscess appeared in the neck, but it subsided in the next two weeks without being opened. January 20 : The patient began to have frontal headaches. January 25 : A swelling appeared in the right parietal region. January 31 : There were sensory and motor attacks of Jacksonian epilepsy beginning, it was said, in the right upper limb and at times spreading to the right and, to a less extent, the left lower limb. There was no loss of consciousness. Examination showed disturbance of postural sensibility in the right big toe and, to a slight extent, in the right thumb. The plantar reflex on the right side was doubtfully extensor. First operation.— January 31 The right parietal swelling was explored and a sequestrum removed, and an extradural abscess was drained. This did not spread across to the left, but stopped 1 cm. to the right of the middle line. After this operation there was complete relief from headache, and neurological examination showed none of the signs observed after the epileptic attack on January 31. February 13 : Headache in the last two days. This morning he had a Jacksonian seizure without loss of consciousness which began with “ pins and needles ” and twitching in the right leg, and was followed by temporary paralysis of the right upper and lower limbs. February 19 : Headache worse. Vomiting. Slight hemiparesis and severe loss of postural sensibility in the right arm and leg. Second operation.—February 19 : Drainage of subcortical left parietal abscess, 2*5 cm. below the dura, by rubber catheter. About 5 c.c. of thick pus only were obtained. February 24 : Vomiting. Drowsy. Almost complete paralysis of left external rectus. Right hemiparesis now complete in the leg and much worse in the arm. Analgesia to pin over right half of body. Third operation.—February 25 : Further exploration of left parietal lobe by brain needle. Abscess not found. , , February 28 : Slight recovery of voluntary powder in right leg. Still very severe postural loss on the right side. < . March 20 : About 4 c.c. of pus escaped from skin incision in left parietal region. March 24 : Power in right arm began to recover. April 1 : Recurrence of headache and vomiting. Right hemiparesis again practically complete. Right-sided sensory loss as before. Dysarthria. Slight papilloedema. Fourth operation.—April 2 : Subcortical abscess of left parietal lobe drained. Evacua¬ tion of 30 c.c. of thick greenish-yellow pus. Drainage of abscess cavity by catheter. April 9 : Great improvement in power of right side. Slight recovery of postural sensibility at right ankle. An attack of Jacksonian epilepsy beginning in right foot. May 9 : Walking with assistance. May 27 : Discharged from hospital. External rectus weakness has practically disappeared. Slight weakness and spasticity of right arm and leg. Defect of postural sensibility, slight in right hand, considerable in right foot. July : Returned to work. March, 1934 : Regularly at work as a labourer. Turns right foot inwards a little as he walks, but no other disturbance of power. Defect of postural sensibility, very slight in right thumb, slight in right big toe.