CASE HISTORY

The patient complained of headaches all his life, cough for 12 years, shortness of breath for 2 years, weakness for 3 or 4 months and swelling of ankles for 1 month. The headaches were always frontal and he always knew that they were coming on as he was in especially good spirits the day before. While the headaches lasted, he was bilious, vomited and slept for varying periods. At the age of 12 it was discovered that his left eye was blind. He had had cough, with a little white sputum for some time. Breathlessness and ankle swelling increased gradually. On examination he was slightly dyspnoeic, had a bluish face. The left eye was blind. There was pulsation of the veins of neck, and a marked kypho-scoliosis, with deformity of the chest, which was covered in fleshy moles. B.P. 105/65. Heart size could not be determined. No murmurs. Diagnosis was right sided heart failure from cor pulmonale. He died 9 days after admission.

PATHOLOGY

The specimen consists of part of the base of the brain. The left optic nerve (on the right) shows a fusiform swelling, part of which has been removed for histological examination. The cut surface cannot be seen clearly in the specimen. At autopsy the outer part of the cross-section was pale, white and oedematous and the inner part yellowish colour. The right optic nerve is normal.