Abstract Though long a subject of controversy, the question of whether or not there is a significant relationship between the side of greater choking of the optic disk and the side of the tumor remains undecided. This question has considerable theoretical importance. It bears on the etiology of choked disk, and on the disturbances produced by expanding intracranial lesions. Martin1 studied 55 cases of intracranial tumor with unequal choked disk, and found that in the majority (71 per cent) the greater choking was on the same side as the tumor. Paton2 studied 48 cases and found that in only 52 per cent was the greater choking on the same side as the tumor. He observed that tumors of the temporal lobe tended to give homolaterally greater choking more often than did tumors in other positions. Gunn,3 analyzing Martin's data, had earlier made a similar observation. MATERIAL AND METHOD References 1. Martin, J. M.: Optic Neuritis in Intracranial Tumors , Lancet 2:81, 1897.Crossref 2. Paton, L.: Clinical Studies of Optic Neuritis in Its Relationship to Intracranial Tumors , Brain 32:65, 1909.Crossref 3. Gunn, M.: Localisation of Intra-Cranial Tumours , Brain 21:332, 1898.Crossref 4. Unequal choked disk is used here to mean a difference in the amount of swelling or secondary atrophy of the two nerve heads. When no secondary atrophy was present, the side of greater swelling was considered the side of greater choking. When secondary atrophy was present, the side of greater atrophy was considered the side of greater choking. No cases were included in which it was reported that there was primary atrophy. I am aware of the difficulties involved in the measurement of swelling and atrophy of the nerve head. In this series there are undoubtedly cases in which the examiner erred. The assumption is made that errors tend to cancel themselves. Confidence in the accuracy of these records is strengthened by the knowledge that in a great number of cases the ophthalmologic examination was made independently by two examiners and that in only five such cases (which were discarded) was there a disagreement as to the side of the greater choking. 5. Because a discussion of homolaterality and of contralaterality is confused by the inclusion of cases of tumor involving both sides of the brain, cases of tumor of midline structures were discarded. Because of the difficulty of ascertaining from operative notes whether or not cerebellar tumors and tumors of the basal ganglia involved one or both sides of the brain, such cases were also discarded. 6. Parker, W. R.: Relation of Choked Disk to the Tension of the Eyeball , J. A. M. A. 67:1053 ( (Oct. 7) ) 1916Crossref 7. Mechanism of Papilledema , Arch. Neurol. & Psychiat. 14:31 ( (July) ) 1925. 8. Swift, G. W.: Choked Disk in Intracranial Lesions: Mechanical Factors in Its Causation , Northwest Med. 26:579, 1927 9. The Transverse Sinus and Its Relation to Choked Disk , Arch. Ophth. 3:47 ( (Jan.) ) 1930.
Archives of Neurology & Psychiatry – American Medical Association
Published: Apr 1, 1932
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