Nervous and mental diseases . toxic cases it may represent the local action of the poison. Deutsch-mann^ insists that it is due to pathogenic organisms which enter fromwithout. Pressure is probably by far the most frequent cause, and thedetection of a choked disc should always suggest abnormal intracranialpressure and the possibility of brain tumor. Atrophy of the optic nerve may (1) follow papillitis and retinitisor choroiditis; (2) it may result from injury or inflammation to thenerve-trunk; (3) it may be associated with sclerotic disease in the brainand spinal cord; (4) it may be due t
Nervous and mental diseases . toxic cases it may represent the local action of the poison. Deutsch-mann^ insists that it is due to pathogenic organisms which enter fromwithout. Pressure is probably by far the most frequent cause, and thedetection of a choked disc should always suggest abnormal intracranialpressure and the possibility of brain tumor. Atrophy of the optic nerve may (1) follow papillitis and retinitisor choroiditis; (2) it may result from injury or inflammation to thenerve-trunk; (3) it may be associated with sclerotic disease in the brainand spinal cord; (4) it may be due to diabetes, malaria, or syphihs;and (5) it may be of unknown causation. The atrophy consecutive to papillitis is easily understood, and of thesame nature are the retinitic and choroiditic forms. Injury to the opticnerve naturally results in atrophic degeneration of the nerve-head. Thatform of optic atrophy found in about a tenth of the cases of locomotorataxia, often present in paretic dementia, and not infrequent in multiple. Fig. 34.—Optic neuritis. Fig. 35.—^Atrophy of the optic nerve. or disseminated sclerosis, has an importance quite its own. Atrophy isfound in amaurotic idiocy and in the cerebellar form of family ataxia. The symptoms and ophthalmoscopic pictures are tolerably uniformfor the various forms. In the variety associated with tabes the disc isoften grayish, translucent, and shows the stipling of the lamina the postpapillitic form the translucency and stipling are less amaurotic idiocy there is a peculiar bluish spot at the site of themacula about twice the size of the disc, presenting in its center abrownish-red spot strongly contrasting with its surrounding patch andresembling a central embolism or hemorrhage. At the same time the disc1 Jour. A. M. A., Jan. 30, 1909. ^ Ueber Neuritis Optica, 1887. DISEASES OF THE OCULAR NERVES 107 is atrophic. In all forms of atrophy the disc is sharply outlined fromthe surrounding retina by its pallor
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