On diffuse encephalitis : with an account of a case in which the patient survived / by R. Lawford Knaggs and R. Conyngham Brown.

  • Knaggs, Robert Lawford.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: On diffuse encephalitis : with an account of a case in which the patient survived / by R. Lawford Knaggs and R. Conyngham Brown. 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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    He was unable to leave bis bed for eight months, and the medical man who saw the patient at this time has described him as having a “ purely vegetative existence.” The pathological appearances suggest that there occurred during this period : (1) A sub-acute encephalitis involving the whole or greater part of the R. hemisphere, and producing a softening of the affected area. (2) Inflammatory effusion into the brain substance, into the ventricles, and into the lymph spaces on the surface of the brain, giving rise to increased intra-cranial pressure and to signs of compression. (3) Dilatation of the R. ventricle with absorption of the softened and inflamed brain tissue surrounding it in consequence of the increased intra-ventricular pressure ; and (4) . Prom the same cause, dilatation of the L. ventricle, but without absorption, because the L. hemisphere was not involved in the inflammation, and was of normal con- sistency. (5) Loss of function of those parts of the brain which had been or were inflamed. Prolonged increased pressure would lead to absorption and recession of the softened inflamed brain tissue wherever it was exposed to it, whether upon the surface of the brain or within the ventricles, and since the ventricles are in direct communication with the lymph spaces upon the surface of the brain, any increase of pressure within the ventricles would speedily equalize itself throughout the whole cerebro- spinal canal. In order, therefore, to explain why absorption of brain tissue has occurred only at the expense of the softened parts of the ventricle walls from within, it is necessary to account for the intra-ventricular contents being maintained at a higher tension than normal, whilst the pressure upon the surface of the brain hardly varied from what was natural ; and this can be done if a plausible reason can be suggested to show that the intra-ventricular fluid was prevented escap- ing by the iter. The maintenance of an ordinary pressure upon the