The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
=Hæmorrhages=: (_a_) _Subconjunctival hæmorrhage_ usually makes its
appearance at the outer canthus of the eye, progressing inwards towards
the corneo-scleral margin, and, in the most severe cases, completely
surrounding the cornea, bulging the conjunctiva forwards in such a
manner as to constrict the field of vision. The extravasated blood is
usually bright red in colour, makes its appearance within a few hours of
the accident, and reaches its maximum within thirty-six to forty-eight
hours.
In some cases a condition of subconjunctival œdema (chemosis) is
observed. This also usually originates at the outer canthus.
Taken by themselves, neither hæmorrhage nor œdema are of any great
diagnostic value. Both conditions, however, aid materially in confirming
the diagnosis.
The blood is almost invariably completely absorbed, and no ill effects
remain.
(_b_) _Palpebral and peri-palpebral hæmorrhage_ is seen in most cases of
fracture of the anterior fossa. This form of hæmorrhage differs from the
one mentioned above in that it usually commences at the inner canthus of
the eye, thence progressing in the outward direction. The extravasated
blood may be wholly anterior to the suspensory ligaments of the lid, in
which case it may be surmised that the fracture only involves the
perpendicular plate of the frontal bone. More commonly, however, the
cribriform plate of the ethmoid shares in the lesion, in which case
palpebral, peri-palpebral, and subconjunctival hæmorrhage are all
present.
(_c_) _Orbital hæmorrhages_ may be so extensive that marked forward
protrusion of the globe exists. The time at which proptosis makes its
appearance, and the degree to which it progresses, vary according to the
nature of the lesion. Thus:--
Proptosis severe, appearing implies a fracture associated with
almost at once, injury to the cavernous sinus
or internal carotid artery.
Proptosis moderate, and „ a fracture involving the
appearing after a few hours, walls of the orbit, the blood
being derived from lacerated
ethmoidal and other small
vessels.
Proptosis appearing days or „ a fracture involving the
weeks after the accident, region of the sphenoidal body
usually progressive, and complicated by the
formation of a fistulous
communication between the
cavernous sinus and the
carotid artery (see Traumatic
orbital aneurysm).
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