Mode of healing after successful operation.
Previous to successful evacuation, the brain immediately surrounding the abscess cavity is compressed and anæmic. As soon as drainage is supplied, it swells out like a sponge, more or less obliterating the cavity. The closure of a cavity by means of the formation of granulation tissue probably never occurs, and, if the falling together of the surrounding brain is insufficient to obliterate the cavity, final closure is completed by the in-dragging of the overlying tissues—scalp, membranes, and brain becoming intimately fused together.
Symptomatology.
The symptoms must be considered under the following headings:—
| The | symptoms | peculiar | to the | INITIAL | stage | of the | abscess |
| „ | „ | „ | „ | LATENT | „ | „ | „ |
| „ | „ | „ | „ | MANIFEST | „ | „ | „ |
| „ | „ | „ | „ | TERMINAL | „ | „ | „ |
The INITIAL stage.
If a patient suffering from brain abscess is capable of answering questions, it will usually be found that he dates his illness from some particular day when he was sick, experienced a shivering attack, or suffered from a severe attack of headache. Further inquiry, however, will almost always elucidate the fact that, for some days or weeks previously, he was not feeling well, suffering from insomnia and loss of appetite, and experiencing occasional attacks of headache. Friends and relatives may volunteer information as to general irritability, alteration of manner, incapability of mental concentration, and worry over family and financial matters.
At this stage the headache is commonly referred to the frontal region, less frequently localized to the region of the brain involved. The patient sleeps badly, and there is often a slight rise of temperature towards the evening. Occasionally he may vomit, independently of the ingestion of food.
The LATENT stage.
Mental depression becomes more marked, headache is more persistent and now shows a definite tendency to localization, food is distasteful, and bodily wasting becomes evident. The evening rise of temperature becomes more constant, sickness more frequent, and vertigo and giddiness may be noticeable features.