DISEASES OF THE DURA MATER Only two diseases of the dura mater are important from a clinical standpoint, meningeal apoplexy and internal hasnorrhagic pachymeningit is.
Meningeal apoplexy embraces the luemorrhages of the blood vessels of the dura.
As these usually are the direct consequence of severe crania] trauma tism, frequently accompanied by concussion of the brain, a description of their clinical symptoms here is manifestly unnecessary. The methods of diagnosing and treating the.se ha]morrhages can be found in the text books on surgery. FIowever, one point merits special mention. After difficult delivery larmorrhages of the dura mater are frequent. Depend ing upon their extent they either terminate fatally within a few hours or days, with the symptoms of cerebral compression, or excite temporary manifestations of irritation, or run a course with no immediate symp toms to sometimes induce gradual cerebral changes; when this occurs the symptoms which ensue belong to the group of infantile cerebral paralyses. Moreover such pachymeningeal hminorrhages are associated with similar htemorrhages of the pia.
Internal ha,morrhagic pachymeningilis now appeals to the pedia trist inasmuch as it has become diagnosible and amenable to treatment by lumbar puncture. The anatomical sequence in this disease is as follows: during the first year of life, in children debilitated by malnu trition, syphilis, rickets, the infectious diseases, etc. (scurvy), usually a.s the result of a somewhat milder injury to the skull, an exudation from the inner lamella of the dura supervenes, which forthwith eonstitutes serous external hydrocephalus. Pachymeningeal Inemorrhages into
this fluid follow from time to time, in consequence of which the cerebro spinal fluid becomes tinged with blood. This clinical picture, a detailed description of which we may omit because, apart from the absence of fever, it is practically the same as that of acute leptomeningitis, is domi nated by the symptoms of brain pressure recurring periodieally (bulging of the fontanelles, congestion of the papilla', retinal haemorrhages, vomiting, pulse anomalies, and hydrocephalic stare).
Cerebral compression diminishes as the exudate becomes organized, but within a period of days or weeks returns and, if untreated, death ensues within a few weeks or months, often after hydrocephalus has developed to sueh an extent as to be visible externally.
The diagnosis, when the symptoms mentioned above are present, is possible only if lumbar puncture discloses fluid under increased press ure and uniformly tinged with blood; provided the presence of blood, due perchance to tbe puncture can be excluded. In such a case the diminution of intracranial pressure wrought by the puncture may induce prompt amelioration of the condition and a quicker absorption of the exudate, without fresh hamorrhages resulting from it. Herein lies the possibility of a permanent cure. It is unnecessary to state that this procedure must be supplemented by careful nursing and diet.