These more general symptoms closely resemble those enumerated when discussing lateral sinus thrombosis (see [p. 283]). Headache, however, is of the most intense type, and pain, of a severe neuralgic character, is referred along the course and distribution of the first and second divisions of the fifth nerve.
Treatment.
It has been suggested that exploration could be carried out, the thrombus evacuated, and the cavernous sinus region drained from the naso-ethmoidal region or by approach along the floor of the middle fossa of the skull—an exaggerated Gasserian ganglion operation. Both these methods have been tried, but the difficulties encountered and the want of success tended to show that cavernous sinus thrombosis was beyond the reach of the surgeon. However, of recent date, more hopeful views have been entertained, it being suggested that the globe should be removed, the sinus explored, and the orbital cavity packed with gauze. It is doubtful, however, whether the end justifies the means.
The prognosis in brain abscess, meningitis, and sinus thrombosis.
A patient may be expected to recover from brain abscess, whether temporo-sphenoidal, cerebellar, or frontal, if an early diagnosis be made, if the case be uncomplicated by meningeal infection or sinus thrombosis, and if the evacuation be carried out without any great difficulty. As Sir William Macewen[58] pointed out, ‘an uncomplicated brain abscess may be regarded as the most hopeful of all cerebral affections.’ In fatal cases, death results from general meningeal infection or from the bursting of the abscess into the lateral ventricles.
In meningitis the prognosis is bad, more especially when the process is widespread. Early exposure of the affected region and the supply of adequate drainage offer the only hope of recovery. This, even under the most favourable circumstances, is a desperate remedy.
The prognosis in lateral sinus thrombosis hinges to a large extent on the time at which operative procedures are carried out. When the case is seen and operated on at an early date in the history of the disease, recovery may be anticipated in about 50 per cent. cases. Hunter Tod states that, when all cases are considered of whatever grade, about one-third recover. Death results from pyæmia, septicæmia, meningitis, or brain abscess.
Cavernous sinus thrombosis of the infective variety almost necessarily terminates fatally. Death results from causes similar to those observed in cases of lateral sinus thrombosis.
HERNIA CEREBRI
The term Hernia cerebri was formerly used as inclusive of all those conditions in which the brain protruded through some aperture in the skull, whether such opening was congenital, traumatic, or post-operative.