2 “Die Krankheiten des Gehirns in Kindesalter,” von Dr. A. Steffen, in Gerhardt's Handb., 5 B., i. Abt., 2te Hälfte, p. 380.
The TREATMENT does not differ from that of inflammation of the external layer of the pia.
Hæmatoma of the Dura Mater.
SYNONYM.—Hemorrhagic pachymeningitis.
DEFINITION.—A chronic inflammation of the dura mater, resulting in the formation upon its inner surface of successive layers of false membrane, into and between which there is usually an effusion of blood, the whole sometimes forming a large solid mass between the dura and the cavity of the arachnoid.
ETIOLOGY.—Hemorrhagic pachymeningitis never occurs in healthy persons except from traumatic causes. It is most frequently observed in advanced life, and especially in the male sex. In a large number of cases the blood is in an unhealthy condition, and hence the disease is seen in alcoholism, in scurvy, in acute articular rheumatism, and in the acute febrile affections, as typhoid fever, pleuro-pneumonia, and pernicious anæmia, of which last, according to Huguenin,3 it complicates one-third of the cases. It is frequent among the chronic insane. It is occasionally met with in young children, but with them its causes are mostly unknown; according to Steffen,4 they may consist in alterations of the blood resulting from insufficient nourishment or from the infectious diseases, and from abnormal blood-pressure, as in whooping cough, asthma, etc., as well as from blows on the head.
3 G. Huguenin, “Acute and Chronic Inflammations of the Brain,” in Ziemssen's Encylop., Am. translation, New York, 1877, vol. xii. p. 401 et seq.
4 Op. cit., p. 386.
SYMPTOMS.—Many cases of hemorrhagic pachymeningitis complicating other cerebral diseases can be distinguished by no special symptom from the original malady. Thus, in cases of chronic insanity its existence may not be suspected during the lifetime of the patient. Steffen quotes5 the case, reported by Moses, of a child seven months old who died of catarrhal pneumonia, and who exhibited no symptom which could suggest any disease of the brain or its membranes. The autopsy revealed a pachymeningitic cyst extending over the anterior half of the right hemisphere. When symptoms are present they vary in different cases according to the acuteness of the inflammatory process, the amount and situation of the effusion, and the participation of the pia mater and brain in the disease. In the beginning they are usually indefinite, headache being the most common and often the only complaint. This may continue for weeks without any other indication of disease, but it is frequently accompanied by tinnitus aurium, vertigo, muscular weakness, and contraction of the pupils. Wakefulness and restlessness at night and slight twitching of the facial muscles or of the limbs sometimes occur. There may be no change in the condition of the patient for a considerable length of time (weeks or months), or he may improve to some extent, owing to the absorption of the serous portion of the effusion or to the tolerance of the foreign body acquired by the brain. Sooner or later a fresh hemorrhage is followed by a recurrence, and usually an aggravation, of all the symptoms. Sometimes the patient becomes comatose, and dies speedily with apoplectic symptoms, but this is not common at an early period. The extravasation of blood generally takes place in small quantities at a time, without giving rise to unconsciousness or paralysis. After a period of uncertain duration, when the tumor has attained considerable dimensions a condition of somnolence may take place, the patient sometimes sleeping twenty-four hours or longer at a time. Distinct paralysis rarely occurs, though hemiplegia is sometimes seen, and the paralysis has been observed on the same side with the lesion. When symptoms of compression appear the pupils become dilated. Toward the end of life the patient is usually in a state of profound coma, the pulse is slow and irregular, and the sphincters are relaxed.
5 Op. cit., p. 394.