Pathological study of the pathways of infection to the intracranial structures from foci of inflammation on the face and in the nasal and nasal accessory cavities

Abstract

Having occasion some twenty years ago to study the literature of acute infection of the leptomeninges from inflammatory foci in the nose, nasal accessory sinuses, and pharynx, the writer was much impressed by the fact that in almost every case published in which the author had mentioned the pathway by which the infection had passed from the peripheral focus to within the cranium, the lymphatic system either was stated to be the route or it was suggested that this was the path involved.

Equally remarkable was it that in the numerous cases which had been studied up to that time, no attempt had been made to demonstrate microscopically the pathway of infection.

Moreover, a direct continuity between the lymphatic vessels of the peripheral parts and the intradural structures was unknown to anatomists. A lymphatic system begins in the dura mater and drains through various of the foramina, in the base of the skull into the deep cervical lymph nodes; this system is closed, however, on the inner side having no communication with the pia-arachnoid spaces.