On the clinical significance of double optic neuritis in children and young adults, and on the capacity for recovery from symptoms of tumour of the brain / by C.O. Hawthorne, M.D.

  • Hawthorne, C. O. (Charles Oliver), 1858-1949.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: On the clinical significance of double optic neuritis in children and young adults, and on the capacity for recovery from symptoms of tumour of the brain / by C.O. Hawthorne, M.D. 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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    here we have in addition, giddiness, retraction of the head, anosmia, and certain paralyses, not to speak of the mental phenomena and the slow pulse and subnormal temperature. The second case offers a marked contrast to the abundant evidence provided by the first. With the exception of con- siderable pain in the head and optic neuritis there is no manifest evidence of cerebral disturbance, yet these will be allowed to be sufficient, and more especially as they receive confirmation from a study of the knee-jerk. The observation in this case was made under unusually fortunate circumstances, for whilst the knee-jerks were present when the boy was first seen, they disappeared during his residence in hospital, and they have never since been detected. There is thus no doubt that the patient lost his knee-jerks during the time when he was the subject of headache and double optic neuritis almost certainly due to cerebral tumour. In two other of the cases (Nos. 5 and 7) here submitted with a diagnosis of intracranial tumour the knee-jerks were absent. No doubt before such a conclusion in reference to the knee-jerk is justified the examination demands great care, as unless this is exercised the jerk, though potentially present, may not be elicited. In examining these cases the precautions insisted on by Jendrassik, Buzzard, and Gowers have been borne in mind, and whenever possible the tests have been repeated and confirmed by other observers. The result is to show that of the seven cases the knee-jerks were absent in two (Cases 5 and 7), in one (Case 2) they disappeared under observation, and in another (Case 1) they varied at different stages of the case, being sometimes present or exaggerated and sometimes absent or diminished. The point of importance just now is the restriction in Case 2 of the evidences of cerebral disturbance to double optic neuritis, headache, and loss of knee-jerks, and the necessary inference arising therefrom, viz., that such loss may be a valuable confirmatory sign of intracranial disturbance. Yet it must be remembered that the loss of the knee-jerk did not occur until fully two months after the onset of symptoms; during the greater part of these two months the boy had no