Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
Motor aphasia may result from pressure on the left inferior frontal
convolution; auditory aphasia from abscess in the posterior part of
the superior temporal convolution. Ptosis and lateral squint, with a
fixed and dilated pupil, indicates pressure on the oculo-motor nerve
of the same side.
Abscess in the _parietal lobe_ gives rise to paralysis of the face and
limbs on the opposite side of the body. Abscess in the _occipital
lobe_ produces interference with the visual functions. An abscess in
the _frontal lobe_ may give rise to no localising symptoms, but if it
is on the left side, the power of making co-ordinated movements may be
lost--apraxia--or the motor speech centre may be implicated.
_Terminal Stage._--If left to itself, a cerebral abscess usually ends
fatally by causing gradually increasing stupor and coma, or by
bursting, either into the ventricles or into the sub-arachnoid space,
and setting up a diffuse purulent lepto-meningitis.
When the _abscess bursts into the ventricles_, the patient suddenly
becomes much worse and dies within a few hours. "The pupils become
widely dilated, the face livid, the respiration greatly hurried, and
either shallow or stertorous. The temperature rises within a few hours
with a bound from subnormal to 104° to 105° F.; the pulse from 40 or
50 per minute quickly reaches 120 and over. There are muscular
twitchings all over the body, possibly associated with convulsions and
tetanic seizures, and these are followed by coma and speedy death"
(Macewen).
Spontaneous evacuation of a temporal abscess may take place through
the middle ear.
#Cerebellar Abscess.#--Next to the temporal lobe, the cerebellum is
the most common seat of abscess. Cerebellar abscess is usually due to
spread of infection from a thrombosed sigmoid sinus, either directly
from a sub-dural abscess formed in relation to the walls of the sinus,
or by extension of the thrombotic process along the cerebellar veins.
While the abscess is small, it may give rise to few symptoms, and the
patient may be able to go about, but as it increases in size serious
symptoms develop. There may be nystagmus, and the patient suffers from
vertigo, and is unable to co-ordinate his movements. If he attempts to
walk, he reels from side to side; even when sitting up in bed, he may
feel giddy and tend to fall, usually towards the side opposite to that
on which the abscess is situated. The head and neck are retracted, the
pulse is slow and weak, and the temperature subnormal. There is
frequent yawning, and the speech is slow, syllabic, and jerky. There
may be optic neuritis and blindness. There is sometimes unilateral or
even bilateral spastic paralysis of the limbs from pressure on the
medulla oblongata. The respiration may assume the Cheyne-Stokes
character, occasionally being interrupted for a few minutes, while the
heart continues to beat vigorously. This arrest of respiration is
especially liable to occur during anæsthesia.
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