CHAPTER 32 



CLINICAL CASES 



The following clinical cases have come under observation and treatment 

 since 1919. 



Case 1. — Elsa B., aged 26, was admitted to hospital under the late Sir 

 David Ferrier, in May, 1919, complaining of headache and vomiting. Up to 

 a year prior to admission the patient was a cheerful individual who was employed 

 in a laundry, and was very keen on tennis. Gradually she lost interest in her 

 work and gave up all games. For a month previous to her admission to hospital 

 she had attacks of vomiting, and was unsteady while walking. 



On Examination. — The patient appeared rather depressed, but was quite 

 keen to cooperate in the hope that something could be done to relieve her 

 symptoms. She walked with a staggering gait, but there did not seem to be 

 any tendency to fall to either side. She had a good sense of smell. The visual 

 fields were complete. Bilateral papilloedema was present, more marked on 

 the right side — right, four diopters ; left, three diopters. The pupils were 

 dilated and did not react to light or accommodation. There was loss of con- 

 jugate upward movement of the eyes. There was weakness of the right Vlth 

 nerve and bilateral nerve deafness. The other cranial nerves appeared normal. 

 There was a fine lateral nystagmus to the right. Ataxia was marked and 

 Romberg's sign was positive. The diagnosis of a pontine or pineal tumour 

 was made, and a subtentorial decompression advised. 



Operation. — On 15th May, 1919, a large subtentorial decompression was 

 performed under ether anaesthesia ; there was marked increase of the intra- 

 cranial pressure, but no tumour was discovered. The wound was closed 

 without drainage. Healing was sound and the stitches were removed after 

 ten days. The patient rapidly improved after the operation, the vomiting 

 stopped completely, and the papilloedema subsided. However, a month after 

 the operation the decompression area began to bulge (Fig. 301), and the 

 papilloedema returned. The patient began to go downhill and died two months 

 after her operation. 



An autopsy was performed and the brain removed entire and hardened. 

 No obvious tumour could be seen. After the hardening process was complete, 

 several sections were made through the entire brain, and a pineal tumour was 

 discovered. 



Pathology. — The tumour was situated between the splenium of the corpus 



callosum and the quadrigeminal plate of the midbrain, both these parts being 



invaded by an ingrowth of the tumour (Fig. 302). Its maximum transverse 



diameter in the section examined was 17 mm. and its vertical measurement 



29 449 



