Chronic empyema of the ethmoidal and frontal sinuses, with exophthalmos : operation, death from menigitis, autopsy / by Arnold Knapp.

  • Knapp, Arnold Herman, 1869-1956.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: Chronic empyema of the ethmoidal and frontal sinuses, with exophthalmos : operation, death from menigitis, autopsy / by Arnold Knapp. 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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    pus. A very pronounced purulent collection was situated further back, surrounding the pons and the anterior extremities of both cerebellar lobes. Pus was seen to continue into the spinal canal. The ventricles contained cloudy fluid. The brain itself and the sinuses were normal. On examining the dura on the floor of the anterior cerebral fossa a small coagulum of blood and pus was seen to cover an opening in the membrane at the posterior ex- tremity of the left cribriform plate. The opening in the dura was round, 2-3 mm broad, with thin and discolored margins. The roof of the orbit and of the nasal cavities was removed, showing the defect in the left orbit produced by the operation. There was no retention of pus. The septum and horizontal wall, roof of ethmoidal cells, and orbit remain; there are a few poste- rior ethmoidal cells. These and the adjoining raucous membrane are covered with discolored granulations, which at one point passed through the bony roof of the lamina cribrosa to the under surface of the dura. The posterior wall of the frontal sinus was normal. The sphenoidal sinus was opened and found healthy. The right cribriform plate was also healthy. Remarks.—The active process in this case was a disease of Sonne of the posterior ethnnoidal cells, vv^hich appear to have been closed off by the dilated empyematous cavity, obstructing drainage and causing an extension upwards, as shown by caries of the lamina cribrosa and circumscribed pachymeningitis. These latter changes are of some dura- tion and presumably not produced by the operation. At the same time there is no question but that the operation started the meningitis under the existing diseased condi- tions. Examples of the lighting up, so to speak, of a latent meningeal process are not unusual.