The cerebral and ocular complications of anaemia and the probable relationship of these to thrombosis : an address delivered to the Medico-Chirurgical Society of Glasgow / by C. O. Hawthorne.

  • Hawthorne, C. O. (Charles Oliver), 1858-1949.
Date:
1909
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Licence: In copyright

Credit: The cerebral and ocular complications of anaemia and the probable relationship of these to thrombosis : an address delivered to the Medico-Chirurgical Society of Glasgow / by C. O. Hawthorne. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    among these latter may be placed retro-bulbar neuritis. But the possibility of a peripheral thrombosis cannot be limited to cases coming typically under this diagnosis. The fact is that the unilateral ocular complications of anaemia range from a greater or less degree of papillitis without prejudice to vision, to a condition of complete loss of visual acuity with little or no ophthalmoscopic change. And between these two extremes there are intermediate cases which show in varying proportions, as it were, some measure both of papillitis and of visual defect. Assuming thrombosis as responsible for these facts, it is readily conceivable that the several varieties and com- binations may be determined by the particular site at which the formation of blood-clot takes place. Should this occur at or near the optic disc it may well produce exudation and htemorrhages of a more or less serious character upon and around the disc—a papillitis in short; and with such a con- dition, as is common knowledge, there is no necessary decline of visual acuity. On the other hand, should thrombosis affect vessels in the trunk of the optic nerve behind the eyeball serious interference with vision, and especiall}'^ with central vision, will be a prominent symptom, although, at least in the early stages of such a case, the fundus may appear normal or may show nothing more than some fulness of the retinal veins. In the intermediate cases, that is those in which papillitis and visual defect are both present, it may be sur- mised that thrombosis has involved vessels both on or near the optic disc and also those of the nerve trunk. One further remark in connection with these cases may be added—it does sometimes happen that a patient shows papillitis in each eye and in one or both eyes also a serious reduction of visual acuity. The latter fact, as already suggested, implies a lesion in the optic nerve trunk. Therefore when with double papillitis there is marked visual loss it seems probable that the thrombosis, assuming this to be the responsible lesion, is bilateral and peripheral, and further warrant for this view may be found in cases described as retro-bulbar neuritis in which the affection attacks both eyes, either simultaneously or in rapid succession. Thus there may be distinguished in ansemia two groups of cases in which bilateral papillitis (optic neuritis) is present. In one there is marked visual defect, and here, for reasons just given, the probabilities are in favour of a bilateral peripheral lesion. In the other and more common variety there is little or no impairment of vision. In such circumstances it is sufficient to assume, as has already been