THERE has been much controversy regarding the pathogenesis of the so-called general symptoms of brain tumours. They are often ascribed to one or more factors which produce an increase in the intracranial pressure. It is generally accepted that these factors are: firstly, the increase in the contents of the intracranial cavity produced by the size of the tumour and the surrounding cedema; secondly, the effect on the vascular system, producing rise in the venous pressure; and, thirdly, the effect on the flow of the cerebrospinal fluid.The present work is devoted to the study of the general hydrocephalic symptoms in ioo consecutive cases of increased intracranial pressure. An attempt at clarification of the controversies with regard to the pathogenesis of these symptoms, based on the pathological changes encountered in these cases, is made.
Material and MethodsThe material presented comprises ioo consecutive cases of increased intracranial pressure, 56 with infratentorial and 44 with supratentorial lesions. Of the 56 infratentorial cases, 32 were cerebellar tumours, one subarachnoid cyst between the tentorium and superior surface of the cerebellum, five pineal region tumours, five brain-stem tumours, four cerebellopontine angle tumours, five post-meningitic hydrocephalus, two choroid plexus tumours in the fourth ventricle and two cases of gliosis of the aqueduct of Sylvius. Supratentorial lesions comprised nine parasagittal meningiomas, six thalamic tumours, five temporal, one occipital, four pariet-occipital, five frontal lobe tumours, four extensive tumours in one hemisphere, two lateral ventricle tumours, two suprasellar tumours, one case of corpus callosum tumour, four cases of secondary metastatic nodules irregularly dispersed in the cerebral hemispheres and one case of chronic subdural hematoma.Fifty-one cases were gliomas, of which 29 were in the cerebellum, brain stem and around the aqueduct and 22 in the cerebrum; I2 cases were meningiomas, nine parasagittal, one in the lateral sphenoid ridge, one suprasellar and one infratentorial in the pineal region. The rest comprised IO tuberculomas, eight cerebellar and two hemispherical; four pinealomas; two neurinomas; two choroid carcinomas; one cranio-pharyngioma; one cholesteatoma; four hamangioblastoma cerebelli and two chronic abscesses, one cerebellar and one temporal. In each case serial coronal sections of the brain were made and the extent of the lesion verified. The ventricles were examined with particular attention to their size and position. Paraffin sections stained with H. and E. were prepared from the lesion, parts of the affected and contralateral hemispheres, including the basal ganglia and diencephalon, and the brain stem. The optic nerves and chiasma from six cases showing papillcedema and six cases of post-papilkedemic optic atrophy were examined histologically, using H. and E. and Smith Queigley stains.The clinico-pathological data relevant to our issue and discussions of the pathogenesis of the general symptoms of increased intracranial pressu...
