![]() ![]() ![]() ![]() It has been said that his observation was not repeated for another 300 years. The patient shows a slightly dilated right pupil and the eye is abducted, suggesting a partial third nerve palsy (Figure 1). This illustrated the elevation of a depressed skull fracture. But Pott failed to mention the ocular signs in von Gersdorff’s ancient woodcut, the work of Johannes Wechtlin, contained in his Feldbuch der Wundartzney (Fieldbook of wound medicine) 1517. The redoubtable surgeon, Percivall Pott (1714-1788) detailed his Observations on the Nature and Consequences of those Injuries to which the Head is liable from external Violence and referred to the woodcuts of the surgeon Hans von Gersdorff (c.1455-c.1529). It became a neurosurgical axiom that a fixed dilated pupil occurs ipsilateral to a pressure cone caused by a space-occupying lesion with intracranial hypertension. Not until the early 20th century was the importance of a fixed dilated pupil recognised as an ominous physical sign. Compression or stretching of the oculomotor nerve were considered possible causes, but the related mechanisms of coning and the importance of lateral shift were only more recently realised.įEW investigations of late years have excited more interest than those which have been made into the connection of certain changes in the eye with diseases of the central nervous system, and into the additional means of diagnosis which such changes may afford. The observation of the ominous fixed, dilated pupils in those with expanding brain lesions dates to Richard Bright and Jonathan Hutchinson in the 19th century, but its significance and mechanisms were only debated in the early years of the 20th century. This paper recalls the descriptions and early ideas about the dilated pupil accompanying raised intracranial pressure resulting from head injuries and space-occupying lesions. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |