Christian Albrecht Jensen (1792-1870): An artistic illustration of Foville's syndrome.

Foville's syndrome, a neurological brainstem syndrome, was described in France in 1858. By chance, a talented portrait painter, CA Jensen, probably illustrated the syndrome at the same time in Copenhagen. This note illustrates the importance of observation in both neurology and art and the variety in interpretation of the same picture by viewers.

Achille Louis Foville's atlas of brain anatomy and the Defoville syndrome.

Achille Louis Foville's atlas of brain anatomy (1844) is one of the most artistic and detailed works on neuroanatomy in the medical literature. The outstanding drawings by the 2 artists, Emile Beau and Frédéric-Michel Bion, highlight all the philosophy, ability, and sensibility of A.L. Foville in carefully dissecting the superficial and deep structures of the brain and spinal cord. Several plates show true brain fiber dissections of high artistic and academic value. As a result of an early misrecognition in the medical literature, "inferior Foville syndrome" has been wrongly attributed to Achille Louis Foville rather than his son, Achille Louis François Foville (1832-1887), also called Defoville. Therefore, we suggest that Defoville, who actually described the pontine syndrome for the first time in the neurological literature, deserves to be credited for this syndrome and that the syndrome should be called the Defoville syndrome. Through analyzing the political and scientific events in France in the 19th century, we highlight the invaluable contributions of A.L. Foville and his son to the history of neuroanatomy and neurology.

Classical crossed brain stem syndromes: myth or reality?

Numerous crossed brain stem syndromes have been described, especially in the nineteenth century. While these syndromes are passed on in neurological textbooks, their relevance in clinical neurology remains to be elucidated. To investigate the prevalence of classical crossed brain stem syndromes in clinical practice, we prospectively recruited 308 consecutive patients with signs and symptoms indicative of acute brain stem infarction. Standardized high-resolution MR imaging and multimodal electrophysiological brain stem testing were applied to localize the site of the acute lesion. We performed a computer-based correlation of clinical signs and symptoms of our patients to those reported in the original historical publications for more than 25 crossed brain stem syndromes. Fourteen cases matched the clinical criteria of Wallenberg's syndrome, two patients had Babinski-Nageotte's syndrome, two had Raymond-Cestan's, one showed Weber's, and one Claude's syndrome. All other tested syndromes were not present in the cohort. More than 20% of patients showed different, so far unnamed crossed symptom combinations. In conclusion, except for Wallenberg's syndrome, classical crossed brain stem syndromes do not seem to play a relevant role in clinical neurology. Other syndromes may serve as theoretical models only that illustrate possible neuroanatomical connections in the human brain stem. This is complicated, however, by considerable topographic and terminological inconsistencies.

Hans von Bülow: creativity and neurological disease in a famous pianist and conductor.

Hans von Bülow (1830-1894) was a conductor and pianist of worldwide reputation and founder of many stylistic interpretations of classic and romantic symphonies. The close friendship with Richard Wagner, but not the enthusiastic admiration of his dramatic musical opus, ended abruptly when Hans von Bülow became aware of the betrayal of his wife Cosima and Richard Wagner. Hans von Bülow reported symptoms and signs of neurological disease in many letters that were kept and edited by his second wife Marie. For decades he suffered from chronic neuralgiforme headaches, which were caused by a tumor of the cervical radicular nerves. At the age of 45 years, he suddenly developed a motorsensory deficit in the right arm and hand and a contralateral facial deficit, suggestive of brainstem infarction. He recovered and celebrated even greater successes as a musician, although phases of major depression also interfered with his professional life. In the last, phase of his life, he experienced the consequences of generalized atherosclerosis and cerebral microangiopathy. It was a second cerebrovascular accident of the brainstem that caused his death, only 10 months after his last concert performance. Although his death occurred in Egypt, an autopsy was performed by Professor Ludwig Edinger and the results will be presented.

[Classical crossed pontine syndromes]. / Klassische alternierende Syndrome der Brücke. Eine historisch-kritische und topodiagnostische Analyse.

Definitions of classical crossed brainstem syndromes in the modern neurological literature are often inaccurate and inconsistent. As a result, different clinical syndromes are designated with the same eponym, other crossed syndromes are nearly completely forgotten. In this study, the original historical publications on the classical alternating pontine syndromes of Foville, Millard-Gubler, Raymond, Raymond-Cestan, Brissaud-Sicard, Gasperini, Grenet and Gelle were reviewed and critically analysed. Their anatomic basis and etiology, and the main publications about each syndrome were discussed. We conclude that the syndromes of Foville, Millard-Gubler, Raymond, Raymond-Cestan and Brissaud-Sicard are interpreted in their essential parts concurring to their historical descriptions. Crossed syndromes of Foville and Millard-Gubler are occasionally mixed up with each other. The syndromes in the last decades described as crossed syndromes of Gasperini and Grenet were, however, never described by Gasperini and Grenet. The existence of the Gelle's as "paralysie alterné de l'acoustique" postulated syndrome seems to be very questionable.

[Classical brain stem syndrome. Definitions and history]. / Die klassischen Hirnstammsyndrome. Definitionen und Geschichte.

BACKGROUND: Inaccurate definitions of brain stem syndromes in the literature. METHOD: The original publications of the authors during the last century and the early years of this one were studied in relation to the neuro-ophthalmological diagnosis and neuroanatomy. It is the goal of this medico-historical investigation to compare the knowledge available at this time when the first descriptions were made with the clinical experience and understanding of today. RESULTS: The following classical brain stem syndromes are important for an ophthalmologist: diseases with III-paresis: Weber's syndrome (1863, ipsilateral oculomotor paralysis with alternating hemiplegia), Benedikt's syndrome (1889, oculomotor paralysis and crossed hemiparesis with tremor), Nothnagel Claude's syndrome (III-Paresis with alternating ataxia); diseases with VII-paresis: Millard Gubler's syndrome (1856, nuclear 7th nerve palsy with crossed hemiparesis), Foville's syndrome (1858, conjugate lateral gaze paralysis, ipsilateral nuclear palsy of the 7th nerve, crossed hemiparesis); diseases with VI-paresis: Raymond Cestan's syndrome (1895, abducent nerve paralysis with contralateral hemiparesis). Brain stem lesions are also found in Wallenberg's syndrome (1895, Horner's syndrome, absent corneal reflex, lateropulsion of saccadic eye movements, nystagmus, ataxia, dysphagia, hoarseness, sensory loss over the facial region, contralateral dissociated diminished sensibility (hemiparesis), etc.). The following two syndromes do not belong to the above-mentioned classical examples, because lesions of the long tracts of the brain stem are absent. However, since these two syndromes are accompanied by both ocular and neurological signs which indicate typical lesions of the brain stem, they are also mentioned here: Parinaud's syndrome (1883, paralysis of conjugate vertical gaze and paresis of convergence together with additional neuro-ophthalmological signs) and the Koerber Salus Elschnig's syndrome (1903, 1910, 1913, nystagmus retractorius, vertical gaze palsy, pupillary disturbances, and signs of midbrain disease). CONCLUSIONS: The first descriptions of these syndromes, together with the figures illustrating the neuroanatomical findings in these lesions, are helpful for assessing the clinical picture. Some named syndromes which are used today in clinical diagnosis (e.g. Parinaud's syndrome) do not exactly correspond to the first descriptions in the last century.