Volume 1

Glasgow hospital reports / edited for the committee by George S. Middleton [and others].

Date:
1898-1901
Catalogue details

Licence: In copyright

Credit: Glasgow hospital reports / edited for the committee by George S. Middleton [and others]. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    also. The edges of the disc become gradually visible. The disc resumes a normal appearance only when the neuritis ha& been slight: when it has been of considerable intensity, the disc finally appears abnormally pale in a condition of con- secutive or post-papillitic atrophy. That the atrophy has followed an acute neuritis is frequently evidenced by the filled-in appearance of the disc, by the narrowness of the vessels, often accompanied by white lines along their walls, by the edges being somewhat irregular, and the choroid and retina in the neighbourhood showing signs of previous disturbance, either by alterations in the pigment or by the presence of white spots. Although the discovery of double optic neuritis is strongly in favour of the presence of an intracranial tumour when the other symptoms point distinctly in that direction, yet, when the other symptoms are obscure, too much importance must not be attached to its presence. It occurs in many other conditions, as in cerebral meningitis, cerebral abscess, syphilis,, lead poisoning, anaemia, and in disturbances of nutrition of very various kinds. While, then, the presence of double optic neuritis is a valuable confirmatory sign of the presence of an intracranial growth, it affords us no information as to the position, size, or character of the tumour. It is met with in tumours occupying all positions within the cranium; it is seen with tumours not as large as a walnut, and is sometimes absent although they are very large; and it occurs with every variety of intracranial growth. Finally, it should be borne in mind that an intracranial growth exercising pressure on the chiasma, or on the optic nerves in front of the chiasma, may cause a simple atrophy without any antecedent neuritis. (Hinshelwood.) Paralytic 'phenomena are common, but generally not wide- spread, although hemiplegia is far from rare. In that case the paralysis usually sets in slowly, implicates a limited area at first (e.g. the face or hand), and gradually extends, while- increasing in intensity. This is very suspicious, and the sus- picion is almost converted into a certainty if accompanied by double optic neuritis. Much more frequently there is paralysis