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.

    5/44 (page 1647)
    upper limb-jerks and the knee-jerks were all diminished, more so on the right side than on the left. The ankle-jerks were absent. There was severe sensory loss on the left side. There was anaesthesia of the left leg below the knee, relative analgesia of the left leg and, to a less extent, of the left forearm and hand, severe postural loss in the left thumb and big toe, gross defect of two-point discrimina¬ tion in the left arm and leg, considerable impairment of tactile localization and relative astereognosis of the left hand. The leucocyte count was 7,520 per c.mm. Operation.—February 10, 1934. Under avertin and local anaesthesia a right osteoplastic flap was reflected. It was felt that the lesion might be an abscess or a tumour, but that in either case a wide exploration should be made. A chronic abscess was found occupying the inner half of the right parietal lobe. Its anterior extremity was just behind the site of the old gunshot wound; its posterior extremity extended to within 4 cm. of the tip of the occipital lobe. On the convexity the dura was densely adherent to its central part. Medially it was separated from the falx by a thin shell of white matter. The abscess and its capsule Fig. 4. Case 2.—Right parietal abscess, following old gun-shot wound, dissected out intact with its capsule. were dissected out intact and the resulting cavitj7 measured 7 by 4 by 5 cm. (fig. 4). A gutta-percha drain was put into it and the flap replaced and sutured in the usual way. Pathology.—The abscess and its wall weighed 85 grm. (fig. 5). After removal it was aspirated and the pus, examined by Ur. Panton, contained degenerated pus cells, numerous Gram-positive cocci, and fatty crystals. Culture yielded a pure growth of Staphylo¬ coccus aureus. The organism was haemolytic and in broth grew in ‘ rough ’’ form. Section of the abscess showed that it consisted of a single large cavity and a smaller loculus occupied by inspissated pus which communicated with the main cavity by a foramen, 0-3 cm. diameter (fig. 6). Its wall measured up to 06 cm., thick and that part of it which had been beneath the old gunshot wound in the parietal bone was found to contain a fragment of lamellar bone, measuring 0*5 by 0-3 cm. Contrary to what was thought at the time when the patient was wounded, a small fragment of bone had evidently been driven through the dura and formed the starting point of the abscess.