Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds.

  • Symonds, C. P.
Date:
[between 1923 and 1940?]
Catalogue details

Licence: In copyright

Credit: Some points in the diagnosis and localization of cerebral abcess / by C.P. Symonds. Source: Wellcome Collection.

    1/18 (page 41)
    Section of Otology 41 Some Points in the Diagnosis and Localization of Cerebral Abscess. By C. P. Symonds, M.D. In this paper I shall confine myself to cerebral abscess arising' from suppuration in the ear, and situated entirely within the dural membrane. I shall only refer briefly to those symptoms and signs of abscess in the cerebellar and temporal lobes which are of chief value in making an early diagnosis and localization. I shall then describe in greater detail two less common conditions, the superficial abscess, and the localized non-suppurative encephalitis. Cerebral Abscess. Temporal and Cerebellar. In the early stages the symptoms are, as a rule, those common to retained pus elsewhere ; fever, a rapid pulse, general malaise and anorexia. Headache may be evident but is not commonly severe. This phase may lead directly to an unre¬ stricted suppurative encephalitis with the rapid development of severe headache, vomiting and drowsiness, as the result of increased intracranial pressure. More commonly the suppurative process becomes localized as an abscess cavity with tough walls, through which there is little septic absorption. There is, therefore, no diffuse encephalitis, and the abscess produces signs and symptoms which depend upon its situation rather than its pathology. In this, the common variety of cerebral abscess, the signs of increased intracranial pressure are, in the early stages, limited to occasional headache, by no means always severe, but often experienced on waking, and increased by stooping and coughing. Severe headache, vomiting, drowsiness, and slowing of the pulse, when they develop in such a case, probably mark the occurrence of mechanical obstruction to the outflow from the ventricles with internal hydrocephalus, and may be terminal in their onset. I would emphasize this point in view of the teaching in some quarters still current that headache and drowsiness, vomiting and slow pulse are the cardinal signs of cerebral abscess. In the variety of abscess that I am now discussing this is no more true than it is of cerebral tumour. A recent case of cerebellar abscess will serve to illustrate this point. A man of 21, who had had chronic otitis media for many years, was admitted to hospital on account of occipital headache and profuse discharge from the left ear. He had been at work up till admission. Operation was performed the same day and pus evacuated from the mastoid. On the following day he made no complaint of headache, was alert and sensible, but was observed by the surgeon to have nystagmus on looking to the left and some inco-ordination of the left arm. The next day he complained suddenly of severe headache, began to vomit, and became drowsy. When I saw him twenty-four hours later his pulse had slowed from 75 to 55. He was incapable of speech and almost unconscious, being with difficulty roused to hold his arms out. When he did so the left fell rapidly away to the bed. There was bilateral ankle clonus and both plantar responses were extensor. At the operation, two hours later, an ounce of pus was evacuated from the left lobe of the cerebellum. Within thirty-six hours the signs and symptoms of increased intracranial pressure had disappeared. The plantar responses were flexor, there was no complaint of headache, and he was as alert and bright as he had been on admission. The size of the abscess suggested that it had been present for two or three weeks. In the early stages, therefore, we have to rely chiefly for diagnosis upon the signs of local damage caused by the abscess, together with complaint of intermittent headache. If the symptoms have supervened upon a mastoid operation and a full history is available, an account of fever, malaise and rapid pulse-rate persisting for a