Page:A manual and atlas of medical ophthalmoscopy.djvu/256



Case 1. — Caries of the sphenoid bone ; descending neuritis, at first unilateral; meningitis ; death; necropsy* (PI. III. Figs. 1 & 2.) Lydia H., aged sixteen, applied to Mr. McHardy, at the South London Ophthalmic Hospital, in July, 1875, on account of dimness of sight in the left eye, of a fortnight's duration. Signs of intra-cranial mischief being present, he kindly sent her on to me on July 13. Family history irrelevant ; previous health not good : a suspicion of lung mischief. A year and a half earlier a troublesome alveolar abscess in the upper jaw. Some months before she had a fall and struck her head, but no notice was taken of it. Much headache for the last two months ; left frontal region constant with paroxysmal exacerbations and superficial tenderness of the head : the pain sometimes passed over the head to the back, and to the ears, and down the left cheek. When seen, no symptoms of paralysis could be detected. No affection of hearing. Pupils equal. Vision, right eye ^. Left eye, quantitative perception of light only. The right optic disc and vessels were in every way normal ; the physiological cup large (PI. III. Fig. 1). The left eye presented well- marked neuritis (Fig. 2). The edges of the disc were veiled by a greyish- red striated swelling, over which the vessels curved ; the veins were concealed beyond the edge, but neither arteries nor veins were concealed on the swelling itself. In the centre they passed into a de- pression, in which a narrow white area marked the position of the central cup, which was almost obliterated. Her chest presented signs of old pleurisy, but no evidence of phthisis. Next day the pains increased in severity, and were felt in the face, nose, ears, &c. Some vomiting occurred. Two days afterwards she was admitted, under my care, into the Queen Square Hospital, slight drooping of the left upper eyelid, and defective action of the left superior rectus, having come on. During the next day or two the pain continued, and she was restless and somewhat obtuse. Temp. 99°. On the 18th the right optic disc was still quite normal. On July 19 the somnolence increased, and on the 20th it was with difficulty that she could be roused. She fre-
 * Condensed from notes taken by Dr. Allen Sturge.