On amaurosis, accompanied by pains in the head, two years' duration : convulsions, three months : examination p.-m., cyst in the cerebellum / by James Reid.

  • Reid, James, 1803-1854.
Date:
[1851]
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Licence: Public Domain Mark

Credit: On amaurosis, accompanied by pains in the head, two years' duration : convulsions, three months : examination p.-m., cyst in the cerebellum / by James Reid. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    fissure, behind the vermiform process, which was flattened out, there was found a cyst, the size of a small apple (about 1^ inch diameter). When it was opened, a quantity of transparent yellow fluid escaped, and it collapsed considerably; the internal surface was unifoi-m, pre- senting a soft semi-transparent appear- ance resembling .jelly, and possessing a certain degree of vascularity; small vessels were seen ramifying in its thick- ness at various points, and at one or two spots a minute effusion of blood had taken place into its substance. The wall of the cyst was about a line thick, and, owing to the softening of the con- tiguous substance of the cerebellum, could be readily separated, leaving a ragged surface: the cerebellum was otherwise healthy. The cyst had ori ginated in the central portion of the cerebellum, apparently in the inferior vermiform process, and had pressed into the lobes on either side, but more especially the left; with which, after it had been separated from its connec tion with the right, it was removed. This case, in common with all be- longing to that class of cerebral disease which includes the development and growth of bodies in the encephalon, possesses many points of interest, but I can only briefly allude to some of them. With I'egard to the symptoms, as in- dicating the locality and nature of the disease, we see the same want of appre- ciable relation between the disease and its effects upon the system whicli is so ft'equently noticed in affections of this kind, and which necessarily causes our knowledge of them before death to be so obscure and indefinite. It is tnae that there was sufBcient to warrant the general conclusion that some organic lesion existed in the encephalon; but the more particular determination, iqion which rational and effective treatment must depend, of what that lesion was, and where it was situated, involved questions that were at most, with our present knowledge, hidden in uncer- tainty, and could only be answered in- definitely. In the midst of such uncer- tainty, it becomes of great importance to know the true value of particular symptoms with regard to the conclu- sions that may be drawn from them; and herein, I think, the special inte- rest of the present case consists. It implies also a physiological question of some importance. It is by the earliest, and, at the same time, best marked symptom, in a case of this kind, that we are led to form an opi- nion of the locality of the gi-owth; for, as the disease progi-esses, symptoms are added depending upon neighbouring parts becoming involved, or various changes taking place in the brain; and it is then very difficult—nay, fi-equently im- possible—to separate the symptoms so as to point with confidence to the exact situation of the disease. The existence of an affection of a special sense as the earliest symptom led me with some confidence to. consider the disease as originating in the track and localities assigned to that sense, and to search for it there after death. I was somewhat disappointed to find nothing in these situations, feeling that the value of a prominent and impor- tant symptom in this relation was thereby depreciated. The symptom of amaui’osis, taken in reference to the localisation of the disease in those parts where the sense of vision is thought to originate, was in this case deceptive. How, then, can the amau- rosis be accounted for? This is a question of much difficulty, and one which I cannot at present solve in a satisfactory manner. Pressure will not account for it. We know that this symptom accompanies the develoj)ment of tumours, and many other diseases of the brain, where no direct communica- tion of such disease with the organs of vision can be traced. It is usual in such cases to offer an explanation by remarking that the connection of the brain-fibres of sucb parts with the thalami, the geniculate or quadrigeminal bodies, will afford a solution of the difficulty; but this is merely offering, in most cases, a ])robable exjfianation which requires more extended and accu- ]*ate observation to confirm or refute. It will be better, perhaps, to leave the question open than to hinder inquuy by an incomplete e.xplanation. In con- nection with the frequency of amau- rosis, as one of the symptoms noticed with tumours existing in or about the cerebellum, it may be mentioned that Andi-al, in 30 cases which he had col- lected from various sources, found that it existed, in a more or less complete state, in six only. The symptom which pointed most