Double optic neuritis with paralyis of olfactory nerves, and sensory division of right fifth nerve / by John B. Story.

  • Story, John B.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Double optic neuritis with paralyis of olfactory nerves, and sensory division of right fifth nerve / by John B. Story. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    7/10 (page 7)
    sptices in the nerve at the lamina cribrosa. It is obvious that this dropsy of the nerve sheath may cause neuritis in either of two ways, either mechanically by pressure of the fluid upon the nerve and its vessels, or by the direct influence of the fluid itself brought into contact with the nerve tissue in the lymph spaces in the neighbourhood of the lamina cribrosa. The probability of this latter view, which attributes directly irritating qualities to the fluid present in these cases, is, I think, somewhat higher than that of the former, for no definite relation seems to exist between the amount of distension of the sheath and the intensity of the neuritis it excites, and cases have been observed both of dropsy of the sheath without neuritis, and of neuritis without apparent dropsy. This is the view which is most generally accepted in Germany, but in this country a rival theory presents itself for public approval, which was first put forward by Hughlings Jackson, and afterwards improved upon by Benedikt. According to these authorities a brain tumour (and as brain tumours are among the most common causes of optic neuritis it is the effect of brain tumours we wish most of all elucidated) may cause inflamma- tion in the optic disc by its acting as a source of irritation to the vasomotor nerves connected with the inflamed part. This theory seems somewhat far-fetched, and certainly necessi- tates, as a preliminary to its acceptance, the demonstration that such a vasomotor arrangement exists as would render it possible for a central irritation to produce a definite inflammatory alteration in the tissues of the optic disc. It must not be forgotten, however, that many cases of inflamma- tion of the disc are true examples of decending neuritis which, propagated along the nerve from the brain, as a slight, apparently insignificant tissue change, becomes an intensely acute inflammation, when the escape of the blood and inflammatory products from the affected area is prevented by a structure like the unyielding sclerotic ring which surrounds the nerve at its entrance into the eyeball. The next point of interest in the case is the curious association of paralysis of the first nerve with that of the fifth, without any implication of either fourth or third nerves. This is one of the