[Reprinted from The Medical News, May 14, 1892.] 
A CASE OF ABSCESS OF THE TEMPORO- 
SPHENOIDAL LOBE, AND OF THE 
MIDDLE LOBE OF THE 
CEREBELLUM. 
By FRANK P. NORBURY, M.D., 
ASSISTANT PHYSICIAN, ILLINOIS CENTRAL HOSPITAL FOR THE INSANE, 
JACKSONVILLE, ILL. ; FORMERLY ASSISTANT PHYSICIAN, PENN- 
SYLVANIA INSTITUTION FOR FEEBLE-MINDED CHILDREN, 
ELWYN, PA. 
F. M., a married farmer, thirty-two years old, was ad- 
mitted to the Illinois Central Hospital for the Insane 
four weeks after the development of insanity, a cause 
for which could not be determined. But little of the 
previous history could be learned. Several weeks pre- 
viously to admission to the hospital, the patient com- 
plained of severe headache, and he became dull and 
stupid. A short time afterward “he had seven fits.’’ 
On admission, no symptoms of organic brain-disease 
were observed. Three days later, however, it was noted 
that the gait was cerebellar; vertigo was complained of; 
ptosis appeared, and some aphasia was evident. The 
condition continued for several weeks, when early one 
morning the man had a severe convulsion, followed by 
vomiting. Seven hours later he had another attack of 
vomiting, followed by apoplectic symptoms. He be- 
came unconscious, with face turgid; frothy mucus was 
discharged from the mouth; respiration was slow and 
labored ; the pulse was bounding; the temperature was 
100.20; there was conjugate deviation of the eyes down- 
ward and to the right; the pupils were insensible to 2 
light; there was left hemiplegia, with some hemian- 
esthesia ; there were no muscular contractions; the 
bowels moved involuntarily. On the following, day the 
paralytic symptoms were more extensive, the muscles of 
deglutition being involved. Coma was profound; the 
temperature was 101.20; the pulse 89; the respiration 
40. There was some pulmonary edema. A day later, 
the pulmonary edema was more pronounced; the pulse 
was 94; the temperature 100.4°; the respiration 42. 
Ptosis of the right side was now observed. The next 
day brought little change. The pulse was 98 ; the tem- 
perature 99.20; the respiration 36. On the following 
day the pulse was 120; the temperature 101.20 ; the res- 
piration 56. The patient went into a state of collapse, 
from which he failed to emerge. 
A post-mortem examination was made thirteen hours 
after death. The dura mater was found adherent in 
the occipital region, just above the internal occipital 
protuberance, in an area an inch and three-quarters by 
half an inch. The meninges were engorged on the 
right side. The pia was adherent to the cerebrum be- 
neath the area referred to. On cutting through the falx 
cerebri, cheesy material was found attached to it. On 
removing the brain, shreds of broken-down brain-sub- 
stance and pus were noticed at the base. On section of 
the brain, an unencapsulated abscess was found in the 
right temporo-sphenoidal lobe, extending to and open- 
ing into the lateral ventricle. The centrum ovale was 
uninvolved. The mass of disorganized brain-substance 
was not purulent. A deposit of pus was found at the base, 
in the region of the motor oculi nerve. Further section 
revealed the existence of an abscess in the middle 
obe of the cerebellum. 
The presence of a lesion of the cerebellum had been 
diagnosticated from the pressure-symptoms, the vomit- 
ing, the titubation, and the ptosis, but tumor was sus- 
pected, and not abscess. The terminal symptoms of 3 
the abscess of the temporo-sphenoidal lobe simulated 
those of cerebral hemorrhage. The perforation into the 
lateral ventricle, however, affords the explanation. Pres- 
sure in the region of the internal capsule will account 
for the temperature-range, and the involvement of the 
fourth ventricle for the varied motor symptoms. The 
temperature-range may also be explained by the inflam- 
matory process in the ventricles. The probable cause 
of the multiple abscesses was a traumatism in the 
occipital region at a point externally corresponding with 
the localized adhesion of the dura internally. There 
were no evidences of ear-disease, necrosis of bone, or 
previous suppurative process elsewhere. 
The case reported is interesting, first, because of the 
obscure symptoms attending the abscess in the temporo- 
sphenoidal lobe and the existence of marked signs of 
cerebellar pressure; and, second, because of the infre- 
quency of multiple abscesses from traumatism in the 
regions occupied. 
The latent abscess terminated precipitately, hence the 
apoplectic character of the symptoms.