The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
_Retraction of the head and neck._ Retraction of the head and neck,
stiffness of the nuchal muscles, and even opisthotonos, may be
observed. The existence of these symptoms is always suggestive of
meningeal infection, but an abscess of considerable size, even when
situated in the anterior part of the lateral lobe of the cerebellum, may
so exercise pressure in the downward direction as to cork up that part
of the cerebellum which normally extends into the mouth of the foramen
magnum. The neighbouring upper cervical nerves may then be irritated or
compressed.
_Yawning._ Frequent purposeless yawning is said to be pathognomonic of
cerebellar disease (see p. 165).
_Attitude in bed._ More commonly the patient lies curled up in bed in
the position of cerebral irritation, perhaps more frequently with the
sound side upwards.
(_c_) =Frontal abscess.= The abscess is usually dependent on
long-continued suppuration in the frontal sinus, with deficient drainage
and spread of disease to the surrounding bone. The abscess may be
situated in close relation to the focus of the disease, but, more
commonly, it occupies a more posterior position, so much so that direct
pressure is exercised on the corona radiata proceeding from the
pre-Rolandic or motor area. It would appear also that definite
localizing symptoms do not arise until the abscess has attained
considerable size. The _general symptoms_ peculiar to all cases of brain
abscess are perhaps less definite when the abscess is frontal in
position. Thus, although headache may be localized to the frontal
region, and although optic neuritis may be present, yet vomiting,
alterations in pulse-rate and in respiratory rhythm are less marked than
usual.
The _localizing symptoms_ are often reasonably definite, so much so that
but little difficulty may be experienced in arriving at a diagnosis.
In the earlier stages of the abscess formation motor irritation may
predominate, with the development of _fits of the Jacksonian type_, the
lower and more anterior motor areas being first and mainly affected.
More commonly, however, attention will be directed towards the nature of
the trouble by _paresis or paralysis of the opposite side of the body_.
In this case also the lower motor areas--those responsible for the
opposite side of the face and upper extremity (also the motor
speech-area on the left side of the brain)--are first and chiefly
involved. In some cases--more especially when the abscess is of
considerable size--definite hemiplegia may result.
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