Lectures

Timothy Holmes
1873 The Lancet  
of arterio-venous aneurism in the cavernous sinus, we must not omit to mention that reported by Mr. Ernest Hart in THE LANCET of March 15th, 1862. In this case, -which I myself had the opportunity of seeing, all the symptoms of arterio-venous aneurism were strongly marked, and it was so diagnosed at the time. Mr. Hart believed that the vessel injured was the frontal branch of the ophthalmic, and it might doubtless have been so, but it was always a puzzle to me how the lesion of so very small a
more » ... of so very small a vessel could have given rise to grave symptoms; and now, judging from the many recorded instances in which similar punctured wounds have extended into the cranium, showing the extreme facility with which a pointed weapon may be driven either through the sphenoidal fissure, or the papery bones of the orbit, into the cavernous sinus, I think it more probable that the lesion was in the latter situation, and the vessel wounded the carotid itself. At any rate, all the symptoms were the same as in the proved instances of arterio-venous aneurism in the sinus: the injury, a blow or puncture on the upper eyelid with the forked rib of a parasol, followed by great effusion of blood ; the disease gradually generated during the four years which intervened between the injury and operation ; the perceptible bruit, of a marked arterio-venous character, heard over the whole side of the head and temple; exophthalmus; a large pulsating vessel running over the roof of the orbit and on to the fore'head,-all these are symptoms which are exactly analogous to the proved cases of arterio-venous communication in the cavernous sinus. In fact, a comparison of Mr. Hart's with M. Nélaton's case will leave hardly any doubt that they were of the same nature. These cases show, then, beyond the possibility of doubt, that a wound or fracture may cause rupture of the internal carotid artery within the cavernous sinus, and that this
doi:10.1016/s0140-6736(02)69416-4 fatcat:j3etkclr5jba7pen6siop4stpu