Tumors of the nervus acusticus and the syndrome of the cerebellopontile angle / by Harvey Cushing.

  • Cushing, Harvey, 1869-1939.
Date:
1917
Catalogue details

Licence: In copyright

Credit: Tumors of the nervus acusticus and the syndrome of the cerebellopontile angle / by Harvey Cushing. Source: Wellcome Collection.

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    the only one in the series in which a corneal a r e f 1 e x a was the only cerebral nerve s y m p t o m apart fro m those of the acoustic itself. Another patient (Case VIII) save a history of bilateral trigeminal parsesthesias, but at the time of his first ex¬ amination no objective hypaesthesia of face or mucous membranes apart from a bilateral corneal a r e f 1 e x a was demonstrable. Of the four other patients (Cases IV, XIX, XXIII and XXX) who also gave a history of bilateral parsesthesias, three showed a bilateral corneal areflexa, but there were other nerve symptoms which overshadowed the corneal reflex in importance. There is one other reflex, the loss of which has been observed in a number of cases—namely, a palatal reflex on the side of the lesion, and it may be added that the palate itself is apt to be a little lax on the homo¬ lateral side, whether from a trigeminal, facial or glossopharyngeal involve¬ ment is not quite clear. Trigeminal pain. One striking thing is notable in relation to all of these cerebral nerve symptoms—namely, that paralytic phenomena rather than irritative are dominant. In the case of the trigeminus, though the par- ajsthesias may be regarded as excitatory, neuralgic pain such as one would expect is relatively uncommon. This is the more remarkable when one realizes how flattened and elongated the nerve becomes as it is crowded aside by the growth. Slight neuralgic discomforts were complained of in but a few cases. In Case I there was a history of contralateral infraorbital pain. In Case AT 11 also there were neuralgic pains referred to the lower jaw on the opposite side; in Case XIX to the face and tongue on both sides; in Case X to the ear on the same side. In none of these patients were the discomforts at all distinctive of trigeminal neuralgia of the major type. It is said, however, that a cerebellopontile tumor is capable of producing paroxysms of such a character that they have been mistaken for tic doulou¬ reux and oft-quoted examples have been recorded by Krause,102 by Lexer,112 and Weisenburg.196 The tumor in Krause’s case was a cholesteatoma of the angle, in Lexer’s case a psammoma (apparently arising from the trigeminal sheath, since the VIIth and VIIIth nerves were displaced below the growth), neither of them, therefore, primary acoustic tumors. I feel some doubt, moreover, as to the diagnosis in Weisenburg’s case, for one would have ex¬ pected deafness had the lesion originated from the VIIIth nerve. These cases, therefore, merely serve to emphasize the fact that, though major trigeminal neuralgia may accompany or be produced by a cerebello- pontile-angle tumor, it is rarely if ever a significant symptom of an acoustic neuroma. Furthermore, in true tic douloureux, unmodified by operation, there is no cutaneous hypaesthesia, whereas in the painful neuralgia from pressure of a tumor some sensory loss is demonstrable, and the conditions may thus be easily distinguished. Examples of neurotrophic keratitis, it may be added, though of rare occurrence, have nevertheless been recorded (e. g., Alquier and Klarfeld,9 Babinski11) in association with recess tumors, and this never occurs in true trigeminal neuralgia except as the result of the loss of sensitivity of the cornea following a neurectomy.