CLINICAL CASES 463 



tion downwards and forwards into the midbrain, it would seem that the tumour 

 arose in the pineal gland, which is no longer distinguishable. 



Histology. — Sections show a cellular tumour intersected by numerous 

 capillaries. Some areas show the characteristic carrot-shaped cells arranged 

 in circles, with their long, protoplasmic processes forming a fibrillary network 

 in the centre (pseudo-rosettes) (Figs. 312, 313). 



Case 8. — Henry B., aged 11, came under observation on 4th July, 1935, 

 with a history of more or less constant headaches for two years. However, he 

 was free for some weeks at a time. A week prior to admission he had repeated 

 vomiting attacks which could not be stopped with any kind of treatment. 



On Examination. — He was a well-built and well-nourished boy, and quite 

 intelligent. He complained of double vision and inability to look upwards 

 beyond the horizontal plane. The pupils did not react to light, but reacted 

 quite well to accommodation. The visual fields were normal. There was slight 

 weakness of the right external rectus. There was bilateral papilledema, more 

 marked on the right side. The rest of the cranial nerves appeared normal. 

 There was no loss of sensation in the body and the deep reflexes were normal. 

 The cerebrospinal fluid was under tension, the manometric reading being 250. 

 The fluid was clear and colourless and did not contain any abnormal constituents. 



A radiograph of the skull (Fig. 314) revealed definite hammer markings 

 owing to the increased intracranial pressure. The Wassermann reaction in 

 the blood and cerebrospinal fluid was negative. 



Four days after admission the patient was found to develop skew deviation 

 of the eyes on looking at objects in front of him, and the double vision became 

 constant. 



Operation. — A ventricular puncture was performed and 100 c.c. of air 

 injected into the lateral ventricle. Ventriculography revealed bilateral dilata- 

 tion of the lateral ventricles. A diagnosis of pineal tumour was made, and a 

 large osteoplastic flap was turned down over the right occipito-parietal region. 

 The lateral ventricle was tapped and the occipital pole of the brain retracted 

 outwards through the opening in the skull. The splenium was cut through 

 revealing a large pineal tumour. A portion was removed for examination and 

 the operation was terminated. The general condition of the patient improved 

 somewhat and the wound healed well. 



The microscopical examination revealed an undifferentiated form of 

 pinealoma (Fig. 315). 



Subsequent Progress. — After three weeks, deep X-ray therapy was given to 

 the pineal region through three ports of entry, some nine treatments being given, 

 and the boy was discharged on 1st September with very slight papillcedema 

 and slight ataxia. On writing to the patient three months later from the follow- 

 up department it was found that the boy had died in his sleep six weeks after 

 leaving hospital and no post-mortem examination was held. 



Case 9. — The specimen was obtained from a brain supplied to the Anatomy 

 Department of King's College, London. No history of the case was available. 

 A median longitudinal section of the brain showed a cyst which occupied the 

 centre of the pineal body and compressed the quadrigeminal plate of the mid- 

 brain. The aqueductus cerebri was also compressed, but it was not completely 



