The First CT Scan of the Brain: Entering the Neurologic Information Age.

Computed tomography (CT) scan of the brain transitioned clinical neurology from the educated-guess world to the real computer-age world. One of the first CT scans-published by the British neuroradiologist James Ambrose-showed an intracranial hemorrhage and also suggested the use of iodine to demonstrate abnormal blood-brain barrier. In the USA, CT scans were rapidly commercialized and first placed at Mayo Clinic and Massachusetts General Hospital in the summer of 1973. CT scanning of the brain has revolutionized diagnostic acute neurology and neurosurgery and was the overture to an even larger revolution-magnetic resonance imaging. This historical vignette discusses the development of CT scanning of the brain and its connection with neurocritical care.

The carotid siphon: a historic radiographic sign, not an anatomic classification.

BACKGROUND: After the term carotid siphon was introduced by Moniz in 1927 to describe the radiographic appearance of the intracranial internal carotid artery (ICA), the concept gained popularity in decades following in both the anatomic and the medical literature. However, as conflicting definitions persist in the delineation of proximal and distal sites, does the term carotid siphon provide the precision needed for current anatomic and clinical studies? METHODS: A PubMed search of "carotid siphon" detected >400 articles from the anatomic and medical literature during the past 6 decades. Moniz's text and figures in his original Lancet article and a compilation of other seminal historical articles and references were reviewed to trace the use of the term carotid siphon during this period. RESULTS: Viewing the radiographic silhouette of a normal ICA, Moniz defined the carotid siphon as the series of bends and curves; an additional curvature was identified as a double siphon. Throughout Moniz's works, in text and figures, the boundaries of the carotid siphon were never delineated. Authors who followed attempted to correlate his original description of this two-dimensional radiographic projection with anatomic documentation. CONCLUSIONS: Tracing the origin and usage of the term carotid siphon during 6 decades in the medical literature shows continued discrepancy rather than consensus. The term carotid siphon is historically relevant but can now be supplanted by definitive ICA classification systems, which continue to evolve in contemporary medical and anatomic communications.

Historical perspective of treatments of cranial arteriovenous malformations and dural arteriovenous fistulas.

Cerebral arteriovenous malformations and intracranial dural arteriovenous fistulas represent two important classes of intracranial vascular lesions. This article recalls the history on which current technical advances, including diagnoses, characterization, and treatment, is based. It also describes modern therapeutic options, including microsurgical, endovascular, and radiosurgery techniques.

A proposed grading system for arteriovenous malformations. 1986.

An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.

[Investigating Quisling's brain]. / Undersøkelsen av Quislings hjerne.

The trial against Vidkun Quisling (1887-1945) started on 20 August 1945. The question of whether he might suffer from a brain disease came up in court, and on Saturday 25 August he was examined by pneumoencephalography and cerebral angiography on the right side. Nothing pathological was found. Later on it has been claimed that these examinations were "experiments which today would be regarded as life-threatening". This is not correct; they were standard procedures at the time. What is criticizable is that Quisling was brought back to court in a relatively short time after the examinations. This paper gives a brief historic account of the development of the two methods, emphasising the contributions of Norwegian physicians such as Arne Engeset (1906-73) and Leif Emblem (1907-91). It has been claimed that the pneumoencephalography of Quisling has been used as an example of a normal finding from encephalography in the internationally renowned textbook "Clinical examination of the nervous system".

Concepts of neurosurgical management of chronic subdural haematoma: historical perspectives.

The history of chronic subdural haematoma (CSH), spanning from its possibly earliest beginnings throughout the centuries until the early 1980s, was investigated within the context of four different epochs. In the 'era of uncertainty', successful trephination, the modem method of choice for the treatment of CSH, was developed by neolithic men. Various historical sources indicate that patients with CSH might have undergone surgery at that time. CSH might have been one of the ailments that had spectacular courses of salvation after trephination. The entity of CSH was first described in the 'era of pioneers' in the seventeenth century by Johann Jacob Wepfer. The misconception of 'pachymeningitis hemorrhagica interna' was introduced by Rudolf Virchow in 1857. By the end of the nineteenth century it became more widely accepted that trauma was a possible cause of CSH. Successful neurosurgical treatment of CSH was first reported by Hulke in 1883. Putnam and Cushing, in 1925, focused on surgery as the treatment of choice for CSH. In the 'era of diagnostic refinement', the introduction of pneumencephalography and angiography allowed the diagnosis of CSH much earlier. Subsequently, the typical signs and symptoms of patients suffering from CSH changed from apathy and coma to headaches and discrete focal neurological symptoms. In the 'era of surgical routine', neurosurgical approaches became smaller and less invasive. Removal of the haematoma was identified as the primary goal of surgery. The use of closed system drainage markedly improved reexpansion of the brain after surgery. Burr hole craniostomy and twist drill craniostomy became the surgical treatment of first choice because of their low morbidity and mortality. There is growing evidence, however, that the neurosurgical learning curve has reached a plateau.

The neglected research of Egas Moniz of internal carotid artery (ICA) occlusion.

Egas Moniz is generally remembered for having discovered cerebral angiography in 1927, and having introduced lobotomy as a form of treatment for mental illness in 1935. Less well known is his pioneering research on occlusive cerebrovascular disease, namely internal carotid artery (ICA) occlusion, as documented by cerebral angiography. It is our contention that the medical community has, until recently, largely overlooked this research. His neglected observations on ICA occlusion and the important diagnostic role played by angiography are reviewed. We propose to show how our paper differs from previous publications regarding Moniz's ICA occlusion contributions. Whereas most previous reviews have focused on either the role played by cerebral angiography in the diagnosis of ICA occlusion, or on the importance of Moniz's internal carotid occlusion observations, our review attempts to integrate both topics. We will tie Moniz's ICA occlusion research to his documented use of angiography.

Stroke: historical perspectives.

The author gives a historical account of stroke, the devastating statistics that still plague Americans, what the future holds, the current research, and possible areas for improvement and growth. Now with specialized imaging, diffusion-weighted and perfusion-weighted magnetic resonance imagings may become the technique to rapidly diagnose brain attack. The cutting edge technology now involves balloons, coils, stents, angioplasty, and thrombolytics to save an ischemic penumbra. Of course, the overall goals remain early detection, intervention, and treatment, which today are individualized to each patient; community education of brain attack and what it looks like; and that time is brain survival. Therefore, a brain attack is a true 911 emergency.