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.

    185/326 (page 165)
    One additional point of interest in connection with the trigeminus is the post-operative herpes (e. g., Cases XVII, XVIII and XXIX) which may follow the tumor manipulations, just as after a sensory root avul¬ sion for major trigeminal neuralgia, herpetic eruptions are apt to occur about the lips or nose on the side of the operation. No example, however, of pre¬ operative herpes has been noted in the series. The motor division of the trigeminus, in cases in which the nerve is seriously involved, may be sufficiently affected to cause a definite weakness or paralysis of the masticatory muscles, shown most characteristically as a deviation of the jaw t o w a r d t h e affected side. It was observed in twelve patients (cf. Table 4), always in conjunction with marked sensory impairment. The deflection of the jaw is of some importance in relation to the deviation of the tongue, which will be mentioned in its place. The N. abducens.—Twenty of the thirty patients gave a history of double vision, sometimes fugitive, sometimes persistent, and in eleven of the twenty an objective weakness of the a b d u c e n s on the side of t h e t u m o r was present on ad¬ mission. There was one patient (Case XIV) in whom an abducens weakness was practically the only homolateral cerebral nerve symptom in addition to the deafness. It seems improbable that the abducens is ever directly pressed upon by the tumor, no matter how much it may flatten the pons, for the VIth nerve lies so near the median line that it would be displaced with the pons (cf. Fig. 196), and I believe that a strangulation of the nerve by an overlying vessel, as I have described in connection with cerebellar tumors of other sorts,44 is the more probable explanation. The flue t u a t i n g c h a r a c t e r of the diplopia and the fact that it usually disappears after operation, whereas the palsies of the nerves which are definitely compressed by the growth are apt to persist, also speak in favor of this view. Then, too, in Cases XIX, XXVII and XXX there was a bilateral involvement of the abducentes, which could hardly have been due to the unilateral pressure of the growth. A weakness of conjugate lateral move m e n t. toward the side of the lesion has been noted by many (Bruns, Bruce, Oppenheim. Stewart and Holmes) and poorly sustained ocular movements in this direc¬ tion have been observed in many cases in this series. It may either be as¬ sociated with an abducens weakness or with the nystagmus. When, there¬ fore, secondary atrophy has led to blindness the eyes at rest are said to be deviated toward the side opposite to the growth, though as Bruce35 has pointed out, this depends upon the presence or absence of irritative lesions of Deiter’s nucleus. The matter is of physiological interest rather than of any diagnostic value. The N. facialis.—In nineteen of the thirty patients some degree of facial weakness was present at the time of admission, a percentage of cases slightly lower than that which records some degree of objective trigeminal involve¬ ment as indicated by a relative corneal insensitiveness. In only one patient (Case XVI) was an accompanying areflexa unelicited—that is, only one patient showed a facial weakness without evidence