The neuritic form of albuminuric retinitis / by Arthur J. Ballantyne.

  • Ballantyne, Arthur J.
Date:
[1905]
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Licence: In copyright

Credit: The neuritic form of albuminuric retinitis / by Arthur J. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    ' ^■ - ^ed from TlfE Optitiialmoscoi-f„ April, 1905.] irife NEURITIC FORM OF ALBUMINtJRTC RETINITIS. BY , k'f xAlrthur J. Ballantyne, M.D., ASSISTANT SUKGEON, GLASGOW EYE INFIRMa'kV,.', , Optic neuritis does not often occur as the only'ophthal moscopic change m Bright's disease, and most text-books of general medicine and ophthalmology make no mention of it; but it deserves, nevertheless, to be borne in mind as the failure to recognise its true nature may easily lead to an error m diagnosis. Cases have been described by Heyman Liebreich, Wecker, Schmidt, Magnus, Gowers, and others. ' The typical ophthalmoscopic picture is one of prominent greyish-red swelling of the optic disc, not extending into the surrounding retina ; fulness and tortuosity of the retinal veins ; possibly one or two white spots on the swollen disc, but rarely any haemorrhages or other gross lesions. The picture, in fact, closely resembles that of choked disc, so often seen in cases of intracranial tumour. Gowers and Groenouw emphasize the fact, that this condition occurs m cases presenting other S3Amptoms suggestive of a bram lesion. Thus, one patient of Gowers (of granular kidney) complained of constant severe headache and occasional attacks of sickness ; another patient exhibited mental changes ; and a third had convulsions and coma. In the last case a diagnosis of cerebral tumour was made, but at the examination no bram lesion was present, and the patient was found to have suffered from granular kidneys. In one reported case post- mortem examination showed pachymeningitis hfemorrhagica, while in another, reported by Uhthoff, no brain lesion could be found. These cases emphasize the importance, in cases with optic neuritis and cerebral symptoms, of ascertaining the condition of the urine, before making a diagnosis of cerebral tumour. Gowers is of the opinion, that in all the cases which he has seen, there were slight retinal changes which would have been sufficient to distinguish the cases from ■ those of cerebral neuritis, but these slight changes might be overlooked, on account of the prominence of the nerve changes. In the case reported below, the only such change was a hcemorrhage - near the disc in one eye. It is important to note that the condition seems to warrant a specially bad prognosis, as it is soon followed by a fatal result. ^ . The following case presented no difficulty in diagnosis, but M S^^^ showing the affection in a fairly typical form. Mrs. M., (Bt. 55 years, admitted to Glasgow Royal Infirmary, under the care of Dr: J. W. Allan, i6th August, 1903, with -^welling of legs, breathlessness, and general weal 'iness, the earnest symptoms dating from three months only. She was going about her household duties in a sort of way, until