CLINICAL CASES 459 



Subsequent History. — At the end of May, 1932, the patient was given a course 

 of X-ray treatment ; he seemed very well, and was able to go back to his office 

 in September, 1932 ; he was able to walk quite well. There was no papilledema, 

 but still some lateral nystagmus to the right. The patient had a bad attack of 

 influenza in December, 1932, which was followed by pneumonia which proved 

 fatal in four days. Every effort was made to obtain an autopsy, but this was 

 refused by the relatives. 



Case 6. — Harry F., aged 27, was admitted to hospital on 5th February, 

 r 935j complaining of headaches. The duration of the present headache was 

 about three weeks, but he had had a similar bout of headaches one year pre- 

 viously. The headaches were mostly occipital, but sometimes were on top of 

 the head, mostly on the right side. They lasted for a quarter of an hour, and 

 were worse in the morning. On two occasions he had vomited in the last three 

 weeks, and frequently was nauseated without vomiting. He had double vision 

 for moderately distant objects, which was getting worse. Movement of the 

 eyes was painful. He suffered from giddiness two or three times a week, 

 mostly when standing. There was no tendency to fall to one side more than 

 to the other. There was no deafness, no noises in the head, no loss of power 

 in any part of the body, and no unconscious attacks. There was no difficulty 

 in speech, but he experienced difficulty in swallowing. There was no urinary 

 trouble. He sometimes had numbness at the back of the head, but did not 

 suffer from pins-and-needles in the extremities. 



There was no previous history of ear trouble or of trauma. The patient 

 had fainted once five years ago, and had had Vincent's angina three years ago. 



On Examination. — On examining the fundi on 12th February, 1935, the 

 edge of the left disc was less distinct than that of the right. Papilloedema 

 on the left side was in sharp contrast to a lesser amount on the right. The 

 veins in both fundi were distinctly enlarged. 



On 19th February a stereoscopic X-ray examination of the skull showed a 

 small rounded shadow of calcified pineal, a linear shadow situated at a certain 

 distance from the rounded shadow and quite close to the right temporal bone. 



On 24th February examination of the fields showed no abnormality. The 

 patient continued to complain of severe headaches, and diplopia was still 

 present. 



Operation. — Ventriculography was performed on 7th March. Both lateral 

 ventricles were very dilated (Fig. 309). The patient was given avertin 

 anaesthesia with gas, oxygen, and ether. A large flap was turned down over 

 the right occipito-parietal region. The dura was quite tense, and the lateral 

 ventricle was therefore tapped and some 80 c.c. of fluid withdrawn. The dura 

 mater was then incised and the occipital pole of the brain was retracted out- 

 wards. The inferior border of the falx was now incised after having clipped 

 the inferior sagittal sinus by means of silver clips. The splenium of the corpus 

 callosum was pushed upwards by the underlying tumour ; the splenium was 

 cut through with a knife and the tumour exposed. It was a vascular tumour 

 and a portion was removed with punch forceps. It was considered impossible 

 to remove the tumour owing to the great vascularity, and therefore the occipital 

 pole of the brain was replaced and the dura held together by three interrupted 

 sutures ; the bone flap was removed and the scalp united by a double row of 



