[Space-occupying lesions of the occupital lobe of the cerebral cortex].

The authors report 90 cases of space occupying lesions originating in the occipital lobe, including 58 primary (26 malignant gliomas, II "benign" gliomas, 19 meningiomas, I sarcoma nad I hémangioblastoma (and 32 secondary masses (i. e. 16 metastatic tumors, 15 abcesses and I hydatid cyst). The onset of clinical features was progressive (gradual increase of intracranial pressure : 59 p. 100) rather than acute (41 p. 100 mostly as a visual (II) or a non visual (10) epileptic seizure). The time elapsed between the first symptom and the surgical procedure in any case appeared to be much shorter than in masses with other hemispheric localisation. This is thought to be due to the precocity and the intensity of the increased intracranial pressure, in relation to the blocage of posterior venous drainage. Increased intracranial pressure : only 7,7 p. 100 of the patient were free of IIP. Fundal changes are of little value in excluding this finding since no less than 3 months of evolution are necessary for their appearence. Visual disturbances consisted of acute obscurations (7.7 p. 100), controlateral deviations of head and eyes (3.3 p. 100) and visual field defects = 10 p. 100 of the patients were comatose and unable to be examined, 16.6 p. 100 had normal visual field. All the others had visual field defects wich could be evaluated by campimetric examination in only 26.6 p. 100. These included 14 hemiopias (7 without macular sparing) and 10 quadranopsia, always with incongruence (4 superior and 6 inferior). When the mass was strictly occipital, the same disparity was observed. Finally these visual field defects appeared to be variable and could well recover after surgery. Visual hallucinations were mostly of elementary type (21 p. 100) and always controlateral in cases of strictly occipital lesions. Elaborate hallucinations were rare (2 patients with extensive lesions). 8.8 p. 100 suffered from visual illusions wich always were related to large and right-sided masses. Disturbances of higher functions : Alexia was seen in 33 p. 100 of the left-sided masses (24 p. 100 "agraphic", 9 p. 100 "pure word blindness") Space agnosias of different type was found in 10 p. 100 of the patients, sometimes with purely occipital tumors.