On the value of eye-symptoms in the localisation of cerebral disease / by E. Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1882]
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Credit: On the value of eye-symptoms in the localisation of cerebral disease / by E. Nettleship. Source: Wellcome Collection.

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    surgeons know the cases often called spurious glioma, in which a young child loses an eye with iritis and the clinical appearances of either detached retina or lymph in the vitreous body, followed by shrink- ing of the globe and secondary cataract. This clinical group includes several pathological processes. Some of the cases are, no doubt, in- stances of severe infantile syphilitic eye-disease ; a few may possibly be the results of injury. On dissection, we may find intra-ocular haemor- rhage, inflammation of the vitreous body, or detachment of the retina se- condary to irido-choroiditis (Nettleship, Pathological Transactions, xxxi, 1880; Brailey, Guy's Hospital Reports, 1881, p. 497). The interesting point for our present purpose is, that severe cerebral symptoms some- times occur just before the eye becomes blind with inflammatory sym- ptoms. The two following cases are taken from amongst several others. Dr. B. brought me his little girl, aged eighteen months. The left eye was congested, and very soft ; there was no anterior chamber ; the iris was adherent to the lens-capsule. Three months previously, she had been taken suddenly ill, with quick breathing, dilated pupils, glazed looking' eyes, and unconsciousness ; there were no convulsions. She was seen by a high authority upon diseases of the nervous system. The temperature was 103-1040 Fahr. for a fortnight ; and two or three times it was thought she would die. Very early in the illness, the left pupil was smaller than the right, and the eye red, and soon after- wards a fiery reflection was noticed from deep in the eyeball ; there was no proptosis. The child remained ill for three or four months. Soon after the onset, whooping-cough developed, and the relation between it and the severe cerebral symptoms and ocular inflammation was not clear. In another case, a little girl (Julia B., 3^ years), who had had bronchitis and measles one year before, and whooping-cough six months before, began to suffer one month ago from pain in the head, chiefly in the left forehead ; a few hours later, convulsions set in, and she became, and is said to have remained for a week, totally un- conscious ; on the third day, the left eye was swollen and inflamed, and the iris discoloured ; the child continued to have severe pain in the eyeball for another week, and then quite recovered. When I saw her, the eye was soft, the periphery of the iris retracted, and a yellow- ish-red reflex, devoid of vessels, was seen behind the clear lens. In the first of these cases, the eye-disease seems clearly to have been secondary to the cerebral attack ; in the second case, the pain is said to have been all along localised on the side of the bad eye, and the question perhaps arises whether the convulsions and unconsciousness could have been merely symptomatic of the local affection of the eye. I do not myself think so ; but the question is open for consideration. In regard to these cases of pseudo-glioma with brain-symptoms, we want to know what changes, if any, occur within the skull. I do not know whether these children ever die. If meningitis occur, is there any- thing unusual in its seat or its nature, and why does the child show this peculiar eye-disease instead of suffering from double optic neuritis? We may here remember that a form of choroiditis or panophthalmitis sometimes occurs in epidemic cerebro-spinal meningitis, and rarely after various infective diseases. The questions of pyaemia and of cere- bral thrombosis have also to be considered in connection with such cases.t It may here be observed that, in the rare cases where a patient has died with purulent meningitis after panopthalmitis, or suppuration in the orbit, it has often been impossible to find any continuity between the orbital and the meningeal disease.^ * A more detailed paper on the subject of this paragraph was read by the author before the Ophthulmological Society on Oct. 12 last. (Feb., 1883.) t Hutchinson, Ophth. Hosp. Rep., viii, 146 ; also the author in Med. Times and Gas., 1880; p. 63. t Harlan, Trans. American Ophth. Society, vol. ii, page 542. T. P. Teale, Brain, vol. ii, 423.