History of Anosognosia.

Even if Babinski (1914) is usually considered as the discoverer of anosognosia, other authors before him contributed to the development of this construct. Von Monakow (1885) and Dejerine and Vialet (1893) gave the first descriptions of patients with cortical blindness who were unaware of their disability, but did not distinguish this unawareness from the rest of the clinical description. Anton (1999) described patients with cortical deafness and cortical blindness, considering these defects of awareness as a symptom independent from the neurological dysfunction. He conceptualized them as a phenomenon in its own right and tried to link this unawareness of a disability with specific neuro-anatomical changes. Finally, Babinski (1914) coined the term "anosognosia" to designate the clinical entity conceptualized by Anton (1899) and extended this concept from the unawareness of cortical deafness and blindness to the unawareness of hemiplegia. The choice of the term "anosognosia" to denote the observed phenomenon was important, because referring to "lack of knowledge of the disease" (anosognosia), he not only emphasized the separation between "lack of knowledge" and "disease, " but also suggested a general use of this term, because disease can refer to many other disabilities besides hemiplegia. Further investigations have shown that: (a) brain-damaged patients may be unaware of different kinds of disabilities; (b) anosognosia can be selective, in that an affected person with multiple impairments may be unaware of only one handicap, while appearing fully aware of any others; and (c) lack of acknowledgment of a disease may not necessarily be due to a defective awareness, but must sometimes be considered as an extreme but understable pattern of adaptation to stress. For this condition, the term "Denial of Illness" seems preferable to that of anosognosia. Anosognosia must perhaps be viewed as a multifaceted phenomenon, resulting from both cognitive and motivational factors.

Charles Miller Fisher: the 65th anniversary of the publication of his groundbreaking study "Transient Monocular Blindness Associated with Hemiplegia".

Charles Miller Fisher is considered the father of modern vascular neurology and one of the giants of neurology in the 20th century. This historical review emphasizes Prof. Fisher's magnificent contribution to vascular neurology and celebrates the 65th anniversary of the publication of his groundbreaking study, "Transient Monocular Blindness Associated with Hemiplegia."

Charles Miller Fisher: the 65th anniversary of the publication of his groundbreaking study "Transient Monocular Blindness Associated with Hemiplegia" / Charles Miller Fisher: 65 anos da publicação de seu estudo inovador "Cegueira monocular transitória associada com hemiplegia"

ABSTRACT Charles Miller Fisher is considered the father of modern vascular neurology and one of the giants of neurology in the 20th century. This historical review emphasizes Prof. Fisher's magnificent contribution to vascular neurology and celebrates the 65th anniversary of the publication of his groundbreaking study, "Transient Monocular Blindness Associated with Hemiplegia."

RESUMO Charles Miller Fisher é considerado o pai da neurologia vascular moderna, e um dos gigantes da neurologia no século XX. Esta revisão histórica enfatiza a magnífica contribuição de Miller Fisher na neurologia vascular, particularmente com a celebração dos 65 anos de publicação do seu estudo inovador intitulado "Cegueira monocular transitória associada com hemiplegia".

The History of the Kernohan Notch Revisited.

The history of false localizing signs is intimately linked to the birth of modern neurology and the unraveling of the mysteries of localization through neurological examination at the end of the 19th century. This phenomenon has attracted much attention but has not been properly explained, even in the authoritative handbooks such as that by Oppenheim. A scholarly article written by Kernohan and Woltman in 1929 is considered to be a landmark in the history of neurology and neurosurgery in that it provided the definitive answer and an exhaustive explanation of the problem, leading some neurologists to conclude that the localization of a lesion is not an exact science. However, despite the professional manner in which Kernohan and Woltman presented their case, they did not offer an explanation. In another article published 2 years earlier in 1927, Groeneveld and Schaltenbrand provided a pathophysiological and anatomical explanation of the phenomenon, described in detail. Although Kernohan and Woltman themselves refer to that previous article, it was this article that provided the first logical, clear, indubitable explanation of the phenomenon that we today refer to as the Kernohan notch.

Arthur Simons (1877-1942) and Tonic Neck Reflexes With Hemiplegic "Mitbewegungen" (Associated Reactions): Cinematography From 1916-1919.

Tonic neck reflexes were investigated by Rudolf Magnus and Adriaan de Kleijn in animals and men in 1912 and eventually by Arthur Simons, a neurologist in Berlin and coworker of Hermann Oppenheim. Simons studied these reflexes in hemiplegic patients, who were mainly victims of World War I. This work became his most important contribution and remained unsurpassed for many years. The film (Filmarchiv, Bundesarchiv [Film Archive, National Archive] Berlin) with Simons as an examiner shows 11 war casualties with brain lesions that occurred between 1916 and 1919. The injuries reveal asymmetric neck reflexes with "Mitbewegungen," that is, flexion or extension on the hemiplegic side. Mitbewegungen is identical with Francis Walshe's "associated reactions" caused by neck rotation and/or by cocontraction of the nonaffected extremities, for example, by closing of the fist (Walshe). The knowledge of the neck reflexes is important in acute neurology and in rehabilitation therapy of hemiplegics for antispastic positions. Simons' investigations were conducted in the early era of increasing use of cinematography in medical studies. The film had been nearly forgotten until its rediscovery in 2010.

William Henry Broadbent (1835-1907) as a neurologist.

By the end of his career, Sir William Broadbent (1835-1907) had become an eminent London general physician who had been appointed Physician-in-Ordinary to King Edward VII and to the Prince of Wales. Previously he had been Physician-in-Extraordinary to Queen Victoria. At earlier stages in his professional life, he had played a significant role in the development of clinical neurology in Victorian-era Britain. In 1866, he had enunciated a principle (Broadbent's hypothesis) that for the first time satisfactorily accounted for the mechanisms by which the trunk and bulbar muscles and the upper face were spared in hemiplegia. He had also carried out original investigations into the distribution of fiber tracts in the human cerebral hemispheres. At intervals over the years, he published on aspects of aphasia and developed a rather complicated though logical conceptual schema of the presumed anatomical background to the process of speech, based on clinic-pathological correlations. His role in all this neurological research and his other contributions on subjects such as neurosyphilis have largely been forgotten by subsequent generations.

The construction of anosognosia: history and implications.

The construction of anosognosia as a clinical 'disorder' resulted from the convergence (in the work of various writers and culminating in Babinski) of a name, a concept, and a clinical phenomenon. During the early stages of this convergence, unawareness of neurological dysfunction was not considered as an independent clinical phenomenon. Started in the work of Anton, the process of separating it as a differentiable clinical state is completed by Babinski who reaffirmed the semiological independence of 'unawareness'. The history of the construction of 'anosognosia' parallels the late 19th century debate on the nature and brain inscription of the concept of 'consciousness'.

The unbearable lightness of the extrapyramidal system.

The concept of the extrapyramidal system comprises an amalgam of disparate and often conflicting ideas with a tortuous history. To the theoretical neuroscientist or practicing clinician, it promptly evokes semantic associations that are hardly reminiscent of its original meaning. The purpose of this article is to revisit the sources of the extrapyramidal concept and to examine the transformations that it went through from its inception, in the late 1890s, up to the neuroimaging revolution of the 1980s. Our review shows that the use of "extrapyramidal" as a surrogate for the basal ganglia, disorders of movement, or certain manifestations of spastic hemiplegia does not apply to humans; rather, it represents the historical product of the unwarranted translation of results of animal experimentation into the interpretation of clinical findings on human patients, misguided clinico-anatomic deductions, and fanciful phylogenetic notions. We conclude that the extrapyramidal concept is a valid and robust anatomic concept as long as it strictly refers to the collection of descending fibers originating in a few discrete brainstem tegmental motor nuclei that project to the spinal cord.

[Arthur Simons on tonic neck reflexes in persons with hemiplegia. From the years 1916 to 1919]. / Arthur Simons über tonische Halsreflexe beim Hemiplegiker. Aus den Jahren 1916 bis 1919.

Tonic neck reflexes described in 1921 by Magnus and deKlejn in animals and men were studied in hemiplegic patients who were mainly victims of WWI by Arthur Simons, a neurologist in Berlin and coworker of Hermann Oppenheim. The effect of the asymmetric neck reflexes after head rotation was restricted to the paralyzed side: tonus (spasms) of extension and adduction during mid-position of the head or head version to the paralyzed side; flexion tonus and abduction during head version to the non-paralyzed side; and flexion tonus (spasms) of the paralyzed limbs during flexion of the head and extension spasms by head extension. More than this, hemiplegic "Mitbewegungen" or associated reactions (Walshe) were observed. They are elicited by conscious innervations of the unaffected side, e.g. by fist closure, and are increased or varied by head rotation, the tonic neck reflexes. They occurred in 25%. A film with Arthur Simons as examiner from the years 1916-1919 shows these nearly forgotten phenomena. Their everyday significance was already stressed in 1920, long before the rules of antispastic positions were defined by Bobath.

The three last years of Manuel II Palaeologus' reign between two stroke attacks: aphasia or not?

The authors attempt to solve the enigma about the possible aphasia of the Byzantine Emperor Manuel II Palaeologus (1391-1425) in the 3-year period between his first and his second and fatal stroke. The texts of historians and chroniclers reveal that Manuel remained semi-paralyzed at bed and his motor disability alienated him from the state affairs and condemned him to isolation from all embassies and contact with others, except his family. Only the funeral oration of the Bishop Bessarion raises the suspicion of a speechless emperor. All testimonies referring to this infirmity are examined.

Louis François Bravais and Jacksonian epilepsy.

Although it is known that Jacksonian epilepsy was first described by Bravais in 1827, some 40 years before Jackson began his work on the topic, little has been published on what Bravais wrote. Louis François Bravais (1801-1843) came from a French provincial family, which made a number of scientific, mainly botanical, contributions. In his Paris M.D. thesis, based on 25 instances of what he termed "hemiplegic epilepsy," Bravais described a set of unilateral epileptic seizure phenomena, including postseizure hemiparesis, very similar to those Jackson wrote about in 1870. However, Jackson accepted that the initially unilateral convulsive phenomena could spread to involve both sides of the body, whereas Bravais believed that this was incompatible with his entity, unless the generalization was a very rare event in the sufferer. Bravais in his account refused to go beyond descriptions of phenomena, whereas Jackson reasoned from the phenomena to a new concept of epileptogenesis, and also from them deduced that there must be localized representation of function in the cerebral cortex. Although Bravais had the priority, his work went largely unnoticed until Jackson's insights had made their impact on medical thinking.

Babinski's anosognosia for hemiplegia in early twentieth-century French neurology.

In 1914, Babinski first described "anosognosia"; a term he coined for a phenomenon involving unawareness of disability in hemiplegia. Historical roots of contemporary perspectives on anosognosia after stroke may be found in early discussions among French neurologists. Current notions and debate regarding the roles played by cognition, emotional factors, sensory loss and somatosensory neglect in anosognosia, and the distinctness of anosognosia as a symptom echo the theoretical dilemmas of an earlier past. Historical overview of the development of perspectives on anosognosia enriches our understanding of unawareness of disability.

Stroke in ancient times: a reinterpretation of Psalms 137:5,6.

Stroke was probably first described in Psalms 136: 5-6 of the Catholic Bible, and Psalms 137:5-6 of the Evangelical Bible. Based on the Portuguese, Spanish, English, German, Dutch, Russian, Greek, and original Hebrew Bible, the significance of this Psalm is the invocation of a punishment, of which the final result would be a stroke of the left middle cerebral artery, causing motor aphasia and right hemiparesis.

Stroke in ancient times: a reinterpretation of Psalms 137:5.6 / Acidente vascular cerebral nos velhos tempos: uma reinterpretação dos Salmos 137 (versículos 5.6)

Stroke was probably first described in Psalms 136: 5-6 of the Catholic Bible, and Psalms 137:5-6 of the Evangelical Bible. Based on the Portuguese, Spanish, English, German, Dutch, Russian, Greek, and original Hebrew Bible, the significance of this Psalm is the invocation of a punishment, of which the final result would be a stroke of the left middle cerebral artery, causing motor aphasia and right hemiparesis.

Acidente vascular cerebral foi descrito pela primeira vez provavelmente na Bíblia, nos Salmos 136, versículos 5 e 6, da bíblia católica, e 137, versículos 5 e 6, da bíblia evangélica. Nas bíblias escritas em português, espanhol, inglês, alemão, holandês, russo, grego e no original hebraico, o significado destes Salmos seria a invocação de um castigo, que poderia corresponder a acidente vascular da artéria cerebral média esquerda, levando a afasia motora com hemiplegia direita.

Persisting aphasia, cerebral dominance, and painting in the famous artist Carl Fredrik Reuterswärd.

What about artistic creativity following a cerebral lesion? We studied the case of a prominent right-handed Swedish painter and sculptor who suffered a cerebral hemorrhage at the age of 55 years. The patient displayed a lesion of the left capsular lenticular region, which resulted in a right hemiplegia and sensory loss, with aphasia of the subcortical type. The linguistic impairments recovered well but at 1 year postonset, the right hand was still completely paralyzed. After a period of a few weeks, during which the patient refused to use his nondominant hand, he produced his first left-handed drawing, and by 1 year postonset, he had once again resumed an intensive artistic activity using his nondominant hand. The pictorial works were reviewed by several renowned art specialists: changes of style and even of contents were judged without loss of artistic quality. The result was described as a gain in emotional and artistic intensity. We discuss our observation in the context of the literature and focus on the crucial role of cerebral dominance and hand preference. We conclude that pictorial creativity and language are distinct forms of expressions.