=Murrell, W.—A Case of Double Optic Neuritis from Serous Effusion
(Quincke’s Disease).=—_Lancet_, April 28, 1900.
A schoolboy, aged seven years, was admitted into Westminster Hospital on
January 28, 1900, the only history obtainable being that on the previous
morning he had been brought home in a “fit,” which lasted the greater
part of the day. On admission he was perfectly sensible and talked
freely, but on being put to bed he passed into a condition of
semi-consciousness which lasted for many days. He took no notice when
spoken to, and remained absolutely mute. The face and upper extremities
exhibited choreiform movements of a slow and coarse type. These
movements were apparently purposive in character, and at times he
endeavored to clutch at objects within his reach. Sometimes the arms
were widely extended, and then slowly flexed, as if performing the act
of embracing. Sometimes the movements conveyed the idea that he was
feebly endeavoring to strike those around him. There was no paralysis of
the face or of the muscles of the limbs. The movements were, as a rule,
bilateral, although sometimes the facial movements were unilateral, but
not always on the same side. There was no rigidity of the muscles,
retraction of the head, or opisthotonos. There was nothing to indicate
that the patient suffered from headache, although at times the brows
were contracted and the face wore a worried and anxious appearance. The
bowels were open twice a day and urine and fæces were passed in bed. The
motions were normal in character. The patient was unable to swallow, and
had to be fed by the nasal tube. There was no nystagmus, the pupils were
normal in size and contracted well to light. There was well-marked
double optic neuritis. The temperature was 99.8° F., and the pulse was
108. There was no tenderness or swelling of the joints, and there was no
rash on the skin. No tache cérébrale could be obtained. There was a
little cough, but there was no expectoration. The breath and
heart-sounds were normal. The urine was acid, had a specific gravity of
1018, and contained neither albumen nor sugar. The spleen was not
enlarged. The patient showed no signs of anæmia, but the blood was not
examined. There was no wasting of the muscles, and the knee-jerks were
present, although somewhat sluggish. The tongue was clean, and presented
no sign of having been bitten. The patient would not protrude it
voluntarily, and it had to be examined with the spatula.
The condition of the patient remained practically unchanged for twelve
days. The highest temperature recorded was on the second day, when it
reached 100°; on the following day it was 99.8°, and from that time
onward it was normal. The double optic neuritis continued, and the disks
were observed to be getting paler. On February 13 (the seventeenth day
of the illness) the patient was much more sensible, and recognized his
mother, putting his arms round her neck. He was still unable to talk,
although apparently he endeavored to do so, from time to time uttering a
few unintelligible words. On being asked if he would like an orange he
nodded his head, and he showed some signs of interest in a watch which
was shown to him. The incontinence of urine and fæces continued, but
food was taken with less difficulty. The movements gradually subsided.
On the 17th the patient could say his own name, but beyond that could
utter only inarticulate sounds, and failed to recognize letters or
words, either written or printed. On the 20th he was able to speak
plainly, although incoherently. He endeavored to get out of bed, and
during the night was so noisy that he had to be removed from the ward.
Urine and fæces were still passed under him. On the 22d he was quieter,
and for the first time indicated that he wanted the bed-pan. The optic
neuritis was less marked. On March 1 the patient was able to get up, and
seemed to be quite well. On the 8th the following note was furnished by
Mr. G. Hartridge, who had frequently examined his eyes during the course
of his illness: “Pupils five millimeters each. React well to light, to
convergence, accommodation, and consensually. Right vision 6/6, left
vision 6/9. Right disk getting white; not much swelling of the disk;
edges clearing. Retinal vessels, specially veins, very full and
tortuous. Left disk pale (less so than right), dim; edges blurred.” The
only medical treatment adopted was the administration for a few days of
15 minims of liquor arsenicalis three times a day.