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Relations between tuberculomata of the central nervous system and tuberculous changes in other organs
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ment in the large majority of cases. O~her methods used are treatment by X-rays, section or injection of the superior laryngeal nerve, and of course rest for tlm larynx.
T U B E R C U L O S I S OF T H E CENTRAL N E R V O U S SYSTEM. JAFFE, 12. II., and SCIIULTZ, A. The Relations bet.ween Tuberculomata of the Central Nervous System and Tuberculous Changes in Other Organs. Amer. .I~ev. Tub., 1936, 33,302. :For the purposes of this study the only type of lesion considered is conglomerate tubercle, miliary tubercles in brain and spinal cord, as in acute raillery tuberculosis, liavi,lg been omitted. In 7,000 consecutive autopsies, 49 cases of tuberculoma of the central nervous system were encountered, in all but one of which the brain was the site of the lesion. Tuberculous changes, outside the brain and spinal cord, which were noted, were divided into two groups : one in which the lesions of I~he central nervous system were associated with ~ gencralising tuberculosis, and one in which only isolated hmmatogencub foci were seen. In the firs~ of these groups an early and a late type were distinguished, the early gcneralisation being directly connected with the primary lesion, and the late being due either to the exacerbation of a temporarily quiescent lesion in a lymph gland or to a progressive isolated tuberculosis of the lungs or other organ. In 50 per cent. of the cases of generalising tuberculosis the tuberculomata were multiple, as compared with only 29 per cent. of the non-generalising type. With regard to site of the tuberculomata in this series, only 26 per cent. were found in the cerebellum, 45 per cent. in the cerebral hemispheres, 20 per cent. in the central ganglia, and the remainder in the corpus callosum and pens. In most of the fifteen cases of " e a r l y gencralisation" there were in certain organs, such as brain, spleen, thyroid, &c., older conglomerate tubercles which
[August, 1937
had preceded the final massive dissemination for weeks or even months, and in three cases there was also a spread of the tuberculosis in the lungs by aspiration from an ulcerated primary lesion. The age of the patients with early generalisation averaged 3--4 years. Nine cases o[ late gcncralisation and tuberculoma of tlie brain were associated with an advanced pulmonary tuberculosis. In eigh~ of these cases the tuberculomata of the brain were the only older hmmatogenous loci, while one case showed also a caseous tuberculosis of tubes, ovaries and uterus. In seven cases of isolated hmmatogenous tuberculomata without generalisation, the autopsy fiiidings suggested that a tuberculosis of the lymph glands had been responsible for the invasion of the blood-stream. There was no difference between the two forms of tuberculosis as far as the association with tuberculous meningitis was concerned, the incidence being 67 and 61 per cent., respectively, in the two groups.
MARTIN, J. P. Calcified Intra-Cranial Tubereulomata. Brit. Jourm .Radiol., 1937, iO, 5. Calcified tuberculomata, though uncommon, are much less rare than statistics of cerebral tumours published from surgical clinics would suggest, because such cases are not often treated surgically. Cerebral tuberculomataare common, and though only a small proportion of patients survive the acute stage of the lesion, in the aggregate the number of survivors may be by no means negligible. The writer recalls five cases from his own experience in the past five years,in each of which the opaque masses were discovered in the routine investigation of patients suffer. ing fro,n fits. The evidence as to the diagnosis of tuberculomata varied. In one case the patient was known to be suffering f,'om active tuberculosis; in two others the patients were found to be suffering from chronic phthisis ; one of these patients also had extensive lupus. One patient, a girl of 22, had been treated in a sanatorium for tuber-
TUnERCLa
ment in the large majority of cases. O~her methods used are treatment by X-rays, section or injection of the superior laryngeal nerve, and of course rest for tlm larynx.
T U B E R C U L O S I S OF T H E CENTRAL N E R V O U S SYSTEM. JAFFE, 12. II., and SCIIULTZ, A. The Relations bet.ween Tuberculomata of the Central Nervous System and Tuberculous Changes in Other Organs. Amer. .I~ev. Tub., 1936, 33,302. :For the purposes of this study the only type of lesion considered is conglomerate tubercle, miliary tubercles in brain and spinal cord, as in acute raillery tuberculosis, liavi,lg been omitted. In 7,000 consecutive autopsies, 49 cases of tuberculoma of the central nervous system were encountered, in all but one of which the brain was the site of the lesion. Tuberculous changes, outside the brain and spinal cord, which were noted, were divided into two groups : one in which the lesions of I~he central nervous system were associated with ~ gencralising tuberculosis, and one in which only isolated hmmatogencub foci were seen. In the firs~ of these groups an early and a late type were distinguished, the early gcneralisation being directly connected with the primary lesion, and the late being due either to the exacerbation of a temporarily quiescent lesion in a lymph gland or to a progressive isolated tuberculosis of the lungs or other organ. In 50 per cent. of the cases of generalising tuberculosis the tuberculomata were multiple, as compared with only 29 per cent. of the non-generalising type. With regard to site of the tuberculomata in this series, only 26 per cent. were found in the cerebellum, 45 per cent. in the cerebral hemispheres, 20 per cent. in the central ganglia, and the remainder in the corpus callosum and pens. In most of the fifteen cases of " e a r l y gencralisation" there were in certain organs, such as brain, spleen, thyroid, &c., older conglomerate tubercles which
[August, 1937
had preceded the final massive dissemination for weeks or even months, and in three cases there was also a spread of the tuberculosis in the lungs by aspiration from an ulcerated primary lesion. The age of the patients with early generalisation averaged 3--4 years. Nine cases o[ late gcncralisation and tuberculoma of tlie brain were associated with an advanced pulmonary tuberculosis. In eigh~ of these cases the tuberculomata of the brain were the only older hmmatogenous loci, while one case showed also a caseous tuberculosis of tubes, ovaries and uterus. In seven cases of isolated hmmatogenous tuberculomata without generalisation, the autopsy fiiidings suggested that a tuberculosis of the lymph glands had been responsible for the invasion of the blood-stream. There was no difference between the two forms of tuberculosis as far as the association with tuberculous meningitis was concerned, the incidence being 67 and 61 per cent., respectively, in the two groups.
MARTIN, J. P. Calcified Intra-Cranial Tubereulomata. Brit. Jourm .Radiol., 1937, iO, 5. Calcified tuberculomata, though uncommon, are much less rare than statistics of cerebral tumours published from surgical clinics would suggest, because such cases are not often treated surgically. Cerebral tuberculomataare common, and though only a small proportion of patients survive the acute stage of the lesion, in the aggregate the number of survivors may be by no means negligible. The writer recalls five cases from his own experience in the past five years,in each of which the opaque masses were discovered in the routine investigation of patients suffer. ing fro,n fits. The evidence as to the diagnosis of tuberculomata varied. In one case the patient was known to be suffering f,'om active tuberculosis; in two others the patients were found to be suffering from chronic phthisis ; one of these patients also had extensive lupus. One patient, a girl of 22, had been treated in a sanatorium for tuber-