A system of practical medicine. By American authors. Vol. 5

by Unknown

Phlebitis of the cerebral veins is very likely to run into meningitis, and the two affections are often so closely united that it is difficult to say which was the first. Œdema is a consequence of venous obstruction in the brain as well as elsewhere, and is seen also around some of the peripheral veins connected with the sinuses.

ETIOLOGY.—Venous thrombosis in the brain depends chiefly on three sets of causes, though it must be admitted that there are a few cases where the origin cannot be distinctly traced and where no previous disease has existed. In the marantic form, occurring chiefly in the very old and in children, as well as in cases of wasting and depressing diseases in adults, a simple thrombosis without inflammation takes place. Two conditions, and sometimes three, are combined here to produce the result—feebleness of the blood-current from a corresponding state of the heart, diseased endothelium of the vessels from defective nutrition, and possibly, where profuse watery discharges have been going on for some time, an increased tendency to coagulation from the inspissation of the blood.

Rilliet and Barthez and Von Dusch⁵⁹ give the following tables of ages at which this form of thrombosis has been observed. The observations of the former were made in a children's hospital, and hence do not affect the question of its frequency in later life. Perhaps the rules of admission may account for the absence of cases under one year of age, of which Von Dusch collected several:

	Rilliet and Barthez.	Von Dusch.
Under 1 year	...	5
2 years	2	1
4 years	4	1
5 years	1	1
6 years	1
7 years	1
9 years	2
10 years	1
11 years	1
12 years	...	1
14 years	...	1
Adults (20, 23, unknown)	...	3
53 years	...	1
Aged women	...	2

⁵⁹ Sydenham Society's translation.

The special diseases in which thrombosis is most likely to be met with are given by Bouchut as follows. The same remark is to be made about these as about those of Rilliet and Barthez. The table is given as convulsions from thrombosis of sinuses:⁶⁰

Chronic enteritis	5
Measles and catarrhal pneumonia	2
Chronic pneumonia	5
Phthisis	8
Anasarca without albuminuria	1
Chronic albuminuria	2
Whooping cough and pneumonia	7
Scrofula, tubercle of bones, etc.	1
Gangrene of mouth	1
Diphtheritis	2

Von Dusch gives a number of cases of the same kind, as do many subsequent writers, but without tabulation. Virchow⁶¹ reports a case of congenital variola with thrombosis of the sinuses of the dura mater, the superior and inferior cava, and vessels of the cord.

⁶⁰ Gazette des Hôpitaux, 1879.

⁶¹ Arch., 1859, 367.