Compound depressed fracture of the skull : cerebral abscess, hernia cerebri, recovery : with a consideration of the subject of hernia cerebri based upon one hundred and nine collected cases / by R. Lawford Knaggs ; communicated by Mr. Bryant.

Knaggs, Robert Lawford.

Date:: 1897

Credit: Compound depressed fracture of the skull : cerebral abscess, hernia cerebri, recovery : with a consideration of the subject of hernia cerebri based upon one hundred and nine collected cases / by R. Lawford Knaggs ; communicated by Mr. Bryant. 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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$upper and central part of the frontal bone, with injury to brain. Paralysis of left side. Broken and loose portions of bone removed. In a week hernia cerebri, which increased to size of a duck’s egg in spite of pressure and local applications. Remained stationary for a fortnight, and was then removed by the knife. A spicule of bone was found pi’ojecting from the inner table, and was removed. After the operation there was a slight inclination to rise up, but it soon subsided, and the wound healed. The paralysis gi’adually dis- appeared. The tumour removed was evidently brain substance. Case 75. Longmore, ‘ Brit. Med. Journ.,’ 1882, vol. ii, p. 928.— September 10th, 1879.—Male aged 39. Gunshot wound of right temporal region. 28th.—Supervention of left hemiplegia. No loss of sensation. October 7th.—Paralysis had disappeared. February 11th, 1880.—Invalided home. Wound discharging slightly. April 8th.—Bullet and loose bone, &c., removed. July.—Small hernia cerebri with slender pedicle. 7th.—On probing by the side of the pedicle for loose bone “ the tumour became quickly puffed up to the size of a marble, and giddi- ness, nausea, and headache were produced.” These symptoms subsided on the following day, and the tumour returned to its pi'evious size. Pressure could not be continued as it caused headache. December.—Alarming cerebral symptoms. Status epilepticus. Operation. Ring of dura mater embracing pedicle was divided, and a piece of bone found firmly wedged between them. Brain explored for pus, none found. Hernia cerebri cut off. Incision in dura mater united. Rapid recovery. January 2nd, 1881.—Wound healed. Case 76. G. B. Mallet, ‘Trans. Prov. Med. and Surg. Assoc.,’ vol. vii, p. 343.—William H—, aged 12. Compound depressed fracture about the coronal suture (centre). Brain injured to depth of thi'ee-quarters of an inch. Paralysis of right side. Sight of right eye nearly gone. Loose portions of bone removed. In a week hernia cerebri began to form, and resisted all treatment till it measured 6 inches X 34 inches X 2^ inches in elevation. Then re- moved by the knife as the patient was evidently sinking from con- stitutional irritation. Halfway throiigli the knife encountered a small portion of loose bone. A few days later a disposition to pro- trude was controlled by pressure. The paralysis of leg began to$