Tumor of the Brain Involving the Ocular 
Nerves. 
Specimen presented to the Medical Society of Washington, D. C. 
BY CLARENCE R. DUFOUR, Phak. D., M.D. 
WASHINGTON, D. C. 
Physician In Charge of Eye Department Eastern Dispensary; Ophthal- 
mologist and Otologist to Sibley Memorial Hospital; Assistant in Eye 
and Ear Department of Central Dispensary and Emergency Hos- 
pital, and Instructor in Ophthalmology and Otology, 
Georgetown Medical College. 
REPRINTED FROM THE 
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 
JANUARY IS, 1896. 
CHICAGO: 
American Medical Association Press. 
189C. TUMOR OF THE BRAIN INVOLVING THE 
OCULAR NERVES. 
CLARENCE R. DUFOUR, Phar. D., M.D. 
Mrs. H., widow, age about 56 years was referred to 
me at the Woman's Clinic, in the summer of 1894, on 
account of her eyes. Upon examination I found a 
complete paralysis of the muscles supplied by the 
third, fourth and sixth nerves, an exophthalmus and 
optic atrophy, all on left side. I diagnosed the trou- 
ble as being in the brain and so told the daughter 
who accompanied her. I could obtain no specific 
history. She had been operated upon some months 
previous for empyema of left antrum, the opening 
being made in the cavity of second molar tooth; 
there was free drainage through the nostril when I 
saw her. I kept the antrum well washed out with 
sol. boric acid and gave her sat. sol. iodid of potas- 
sium, 10 gtt. three times daily, increasing one drop 
daily, until she was taking 30 gtt. three times daily. 
Any attempt to increase this amount produced such 
constitutional disturbance that it could not be done. 
She was kept on this treatment until complete symp- 
toms of iodism were manifested, when it was 
changed to 1-16 gr. bichlorid of mercury and 3 grs. po- 
tassium iodid three times daily, and continued for 
months with occasional intermission of a few days. 
No result whatever from the treatment. About the 
middle of the summer she began to complain of in- 
tense pain in her head, which at first yielded to 
anodyne treatment but which soon became constant 
and nothing but morphia would allay. About this 
time there began to be symptoms of loss of sensation 2 
on side of face and anesthesia of cornea, indicating 
that the first division of the fifth nerve was being im- 
plicated. This condition continued, with no abate- 
ment of the symptoms ; she had periods of hallucina- 
tions, and as her daughter was obliged to work away 
from home, and there being no one to leave the mother 
with,the latter was sent to the hospital. It was thought 
best to reopen the antrum so as to establish freer 
drainage; this was done, considerable pus escaping. 
It was then washed out with antiseptic solution two 
to three times daily. An examination of the urine 
was made with results as follows: Amber in color, 
cloudy ppt., acid reaction; small amount of albumin, 
epithelial cells and pus were found. After operation 
on antrum the pain in head subsided for a few days 
but began again and continued with occasional periods 
of intermission. She was discharged from hospital 
in the early part of November. Her condition grad- 
ually became worse, her right eye began to show 
symptoms of incipient atrophy of the optic nerve and 
an external squint was manifested. She was able to 
go about until April 1895 when she had to go to bed. 
She grew worse, her mind wandered and word deaf- 
ness became manifest. On May 3 she died. On the 
following morning the skull was opened and the 
brain removed; It was put into a 2 per cent, solution 
of formalin, and a few days later the examination re- 
vealed the following condition : Gumma of dura mater 
in the anterior part of left middle fossa; this in- 
volved by extension the left anterior temporo-sphe- 
noidal lobe ; the growth surrounded the internal car- 
otid artery, exerting pressure on the cavernous sinus 
and involved the left optic nerve at the commissural 
origin ; considerable edema of the left anterior sphen- 
oidal lobe. A second and smaller gumma involved 
that part of the brain mass which constitutes the left 
olfactory convolution ; the third and smallest lay in 
the angle at the right optic commissure. The bone 
around the first growth had lost its compact covering 
and had become porous ; the dura was very adherent 3 
to the bone. The ocular conditions during life were 
cleared up, I think, satisfactorily by the findings at 
the post-mortem. The cavernous sinus receives an- 
teriorly the ophthalmic vein through the sphenoidal 
fissure, and on its inner walls is found the internal 
carotid artery and the sixth nerve; on its outer wall 
are the third, fourth and the first division of the fifth 
nerve. 
The pressure exerted by the tumor upon the sinus 
explains the paralysis of the muscles and the anes- 
thesia of cornea, etc., this pressure together with 
pressure upon the ophthalmic vein, accounts for the 
exophthalmus by preventing the return flow of blood 
through the angular and ophthalmic veins into the 
cavernous sinus. The pressure also being exerted 
upon the optic nerve in front of the chiasm, was the 
cause of the optic atrophy of left eye. The edema of 
the temporo-sphenoidal lobe, would, 1 think, satisfac- 
torily explain the word deafness. The atrophy of the 
right eye was due to the smallest tumor in the angle 
of the right optic commissure. The cause of the ex- 
ternal strabismus is somewhat obscure, as there was 
no implication of the third nerve on that side; my 
opinion is that there was pressure exerted upon this 
nerve in the region of the sphenoidal fissure, proba- 
bly as it passed through it. The case was referred to 
me by Dr. Heiberger, and the post-mortem was made 
by Dr. D. S. Lamb of the Army Medical Museum, of 
this city. 
1016 I Street, N.W.