The Journal-Lancet, Vol. XXXV, No. 5, March 1, 1915: The Journal of the Minnesota State Medical Association and Official Organ of the North Dakota and South Dakota State Medical Associations — John Shaqi
The Journal-Lancet, Vol. XXXV, No. 5, March 1, 1915: The Journal of the Minnesota State Medical Association and Official Organ of the North Dakota and South Dakota State Medical AssociationsVarious
Science
The Journal-Lancet, Vol. XXXV, No. 5, March 1, 1915: The Journal of the Minnesota State Medical Association and Official Organ of the North Dakota and South Dakota State Medical Associations
Various
Medicine -- Periodicals
_Brain Abscess._--This is most frequently associated with chronic
suppuration of the middle ear and mastoid, and labyrinthine disease.
As stated before, we must consider two principal types, namely, those
outside the dura and those within. They may exist at the same time,
or the intradural abscess may frequently follow, especially in acute
exacerbations, the extradural abscess. The paramount symptom is the
great pain in the head, most frequently localized at or in close
proximity to the abscess. I have, however, found several instances
where the patient located the pain in the anterior portion of the head,
and operation or post-mortem examination disclosed it in the posterior
cerebral fossa. This pain is not at all unlike that in brain tumor,
and there are exacerbations in the headaches sometimes at night, other
times in the mornings, and in one of my cases the patient would have
about ten attacks of severe head-pains within twenty-four hours, and in
the intervals be fairly comfortable.
The next group of symptoms of importance are the focal lesions, which
will correspond to the anatomicophysiologic locations and actions.
These focal symptoms will vary in degree in that they be either
irritative or destructive. So, for instance, a small abscess pressing
over the motor area will cause clonic contraction and a still larger
abscess, especially if it be intradural, will produce paralysis of
that portion of the body governed by that particular area. Again,
if it be located in the cerebellar region it will cause a train of
symptoms of imbalance and loss of interpretation of direction, which
must be carefully differentiated from the irritation of the labyrinth.
In this department there has been much work done by Barany, Ruttin,
Neumann, and other Viennese, and many others to make it possible to
make a differential diagnosis; and there is a great deal more to be
done. One of the most important recent contributions in this regard is
the “pointing test” of Barany in connection with cerebellar lesions;
and careful study and experimenting at every opportunity is very much
recommended, in order to familiarize one’s self with this test. This
in connection with the various labyrinth tests makes the differential
diagnosis much more easy. One must remember that both labyrinthian
irritation in connection with suppuration of the ear and cerebellar
irritation from brain abscess may exist at the same time.
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