[Hans Schliack (1919 - 2008): a personal and professional appraisal]. / Hans Schliack (1919 - 2008): Eine persönliche und wissenschaftliche Würdigung.

Hans Schliack (1919 -2008) was one of the prominent post war neurologists who acted successfully for the emancipation of clinical neurology in the former western part of Berlin and Germany. His scientific work was destined to the theory of segments (dermatomes, myotomes, zones of Head, initially with Karl Hansen in Lübeck), sweat disturbances in neurological disorders and peripheral nerve lesions. The latter issue led - in cooperation with Marco Mumenthaler - to the textbook, which held its leading standard since its first edition in 1965. Schliack's founding editorship of the purely neurological journal "Aktuelle Neurologie" since 1974, his author- and editorship of neurological textbooks and his teaching of numerous coworkers in Berlin and Hannover stress his outstanding role over nearly five decades.

The telodiencephalic ischemic syndrome.

A new cerebral syndrome is described which occurs rather frequently with ischemia affecting the common pathway of the internal carotid and middle cerebral arteries. The syndrome consists of contralateral brachiofacial hemiparesis, possibly with hemianopia and/or aphasia, and ipsilateral thermoregulatory hemihypohidrosis with an ipsilateral central Horner syndrome. It is caused by an ischemic lesion of the crossed pathways descending from the cerebrum and the uncrossed hypothalamo-spinal sympathetic pathways descending through the subthalamic region. It is suggested to name the syndrome "telodiencephalic ischemic syndrome".

[Neurological findings (especially "developmental reflexes") in residents of homes for the aged (author's transl)]. / Neurologische Befunde (insbesondere "Entwicklungsreflexe") bei über 75 jährigen Altenheimbewohnern

86 residents of several homes for the aged in Berlin, aged 75 to 96 years (mean age 86.3 years), were examined neurologically. Many showed the following aberrant neurological signs: Pallaesthesia and dermolexia were extinct in the lower extremities; the ankle jerks could not be elicited; the palmomental, orbicularis oris reflex, grasping and the snout reflexes were positive; there was a hypokinetic-hypertonic motor syndrome. The statistical analyses and the follow-up dynamics of our findings argue for such age-dependent changes of the CNS as the basis for the grasping and snout reflexes and for the involuntary movements of the elderly.

[Romberg: a biographical sketch]. / Lebensbilder von Romberg.

Moritz Heinrich Romberg can be considered the most important founder of clinical neurology as well as a significant reformer in medicine. In the present treatise his life, his oeuvres and his prominent scientific contributions are summarized with newly discovered photos, portraits and documents. A previously unknown Daguerreotype of him should be of particular interest. Romberg's significance and his accomplishments as an internationally renowned figure in medical history are emphasized.

[The suffering of Heinrich Heine]. / Das Leiden des Heinrich Heine.

The analysis of clinical neurological symptoms on the basis of available letters and other documents confirms beyond a doubt the long standing diagnosis of neurosyphilis in the form of chronic meningitis with cranial polyneuritis and wide spread polyradiculitis, formerly called Lues cerebro-spinalis. The symptoms which recurred over 25 years include multiple severe paralysis of cranial nerves, dramatic radicular neuralgias and radicular paralysis in addition to a partial transverse lesion of the spinal cord and terminal coughing and regurgation fits in the absence of symptoms in the cerebrum and brain stem, these symptoms hardly permit different diagnosis. Tuberculosis, lead poisoning, multiple sclerosis or even a myatrophic lateral sclerosis do not explain his neurological symptoms or the cause of his death.

["Abnormal" neurologic findings in the "healthy" elderly]. / "Abnorme" neurologische Befunde bei "gesunden" alten Menschen.

Neuropathological changes and clinical neurological findings of the nervous system of healthy, old people (more than 80 years old) are referenced according to the literature. In addition, the results of a clinical neurological examination of 86 healthy senior citizens (average age: 83.6 years) are demonstrated. The respective findings are summarized in a table according to their frequency. The involution of the human nervous system with age results neuropathologically and clinically-neurologically in damage to the frontal lobe (disinhibition of archaic reflexes), the extrapyramidal system (Parkinsonian walking pattern), the posterior tract of the spine (unsteadiness of walking), and the peripheral nervous system (e.g. loss of the achilles tendon reflex). The Parkinsonian-like walking pattern of the healthy old-aged human is thought to be a disinhibition of an archaic pattern of posture and movement. Brief suggestions for differential diagnosis and therapy are presented.

Hypersexuality--a complication of dopaminergic therapy in Parkinson's disease.

Hypersexuality induced by dopaminergic drug treatment in parkinsonian patients is a rarely reported side-effect. A case history is presented where it occurred together with hyperkinesias while the patient was treated with L-dopa and bromocriptine. An addictive misuse of these drugs complicate the guidance of this patient. Approximately three years after the beginning of hypersexuality he developed several paranoid-hallucinatory psychoses which subsided each time upon dose reduction.

[Complete loss of brainstem-functions following epidural anaesthesia (author's transl)]. / Bulbärhirn-Syndrom bei Epiduralanaesthesie mit Bupivacain

A 77 year old male patient developed complete loss of brainstem-functions following epidural anaesthesia for prostate electroresection. On the basis of anatomical and pathophysiological considerations an attempt is made to explain the development of this event. The most important factor seems to be that the local anaesthetic agent can diffuse into the subarachnoid space via the arachnoid villi, which can protrude into the epidural space. Once in the subarachnoid space the anaesthetic can ascend. By this mechanism a complete loss of brainstem functions may evolve. Survival without residual deficit is possible if immediate intensive care with control of the vital functions is instituted.

[Difficulties and errors in ambulatory therapy of Parkinson disease]. / Schwierigkeiten und Fehler in der ambulanten Parkinson-Therapie.

The clinical findings as well as the follow-up of 52 patients with progressive Parkinsonism were analyzed and the following results obtained: The reasons for the clinical progression of the disease were most often acute secondary illnesses not involving the CNS, Parkinsonism-independent CNS lesions ("Parkinson plus"), the absolute as well as relative L-DOPA overdose and, lastly but significantly, the effects and side-effects of too many prescribed drugs. Our findings resulted in the following therapeutic recommendations: A monotherapy should be used for as long as possible with slowly increasing doses up to the threshold of tolerance. Only if necessary should alternative drugs or a combination of not more than two drugs be used. Parkinsonism progresses even with the present best therapy. So far, it was only been possible to mitigate this progress, but not to prevent it. In the late stage of the disease it is more appropriate to accept some remaining symptoms than to risk an overdose or polypharmacy with its attendant problems.