Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy.

  • Walker, A. Earl (Arthur Earl), 1907-1995.
Date:
[1934?]
Catalogue details

Licence: In copyright

Credit: Congenital dermal sinuses : a source of spinal memnigeal infection and subdural abcesses / by A. Earl Walker and Paul C. Bucy. Source: Wellcome Collection.

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    identical with that seen in the first piece of tissue is present, and in the opposite corner an arc of epithelial tissue, probably a small segment of a hair follicle. Even with these few sections it is evident that the condition present in this case is very similar to that in the first two patients. The extent of the dermal sinus is unknown, but as demonstrated grossly it probably extended at least to the subdural inflammatory mass. As in the previous cases an epithelial tube leading from the skin to an inflammatory mass beneath the dura mater was found at operation. The histopathology of this was similar to that of the specimens from the first two cases. However, it is interesting to note that there was no pigment in the basal layers of the epithelium of the tube, such as was present in abundance in the normal epidermis. The same phe¬ nomenon was noted in Case 2 in which the surface epithelium, though from a white girl, was heavily pigmented, whereas that from the tube contained no pigment. Dr. Samuel C. Harvey, of the Yale University School of Medicine, has also informed us that several years ago a similar case was operated upon in his clinic. This case was recorded by Moise [5] and is related here in detail. Case 4.—A white male, aged 18, was admitted to the New Haven Hospital on September 10, 1924. He had always had in the lower lumbar region a sinus discharging a watery fluid at short intervals. A week before admission the skin about the sinus became tender, and two or three days later his back began to ache. The day before admission he had headache, general malaise and anorexia. There was no nausea, vomiting or convulsions. When admitted his temperature was 101'8° F., pulse 86, and respirations 20 per minute. He appeared ill, his face was flushed, and his expression anxious. The heart, lungs and abdomen were normal. Neurological examination showed a very stiff neck, normal tendon reflexes in the upper extremity, but absent knee and ankle jerks. Kernig’s sign was present- In the midline over the upper sacral region was an area of red and tender skin surrounding a small sinus from which some thin pus could be expressed. A roentgenogram of the sacrum showed a sacralization of the 5th lumbar vertebra, an irregularity in the fusion of the spines of the 5th lumbar and the 1st sacral vertebras, and a flattening of the spine of the 1st sacral segment with a defect below this level. Lumbar puncture provided a cloudy cerebrospinal fluid under increased pressure containing 1,450 cells per cubic millimetre, predominately polymor¬ phonuclear leucocytes. A few Gram-negative cocci were seen in smears, and culture showed haemolytic Staphylococcus albus. Daily lumbar puncture failed to impiove his condition, so operation to remove the sinus was advised.