Jules Cotard (1840-1889): his life and the unique syndrome which bears his name.

Dr. Jules Cotard (1840-1889) was a Parisian neurologist who first described the délire des négations. Cotard's syndrome or Cotard's delusion comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost organs, blood, or body parts to believing that one has lost one's soul or is dead. In its most profound form, the delusion takes the form of a professed belief that one does not exist. Encountered primarily in psychoses such as schizophrenia and bipolar disorder, Cotard's syndrome has also been described in organic lesions of the nondominant temporoparietal cortex as well as in migraine. Cotard's delusion is the only self-certifiable syndrome of delusional psychosis. Jules Cotard, a Parisian neurologist and psychiatrist and former military surgeon, was one of the first to induce cerebral atrophy by the experimental embolization of cerebral arteries in animals and a pioneer in studies of the clinicopathologic correlates of cerebral atrophy secondary to perinatal and postnatal pathologic changes. He was the first to record that unilateral cerebral atrophy in infancy does not necessarily lead to aphasia and was also the pioneer of studies of altered conscious states in diabetic hyperglycemia.

Monozygous twins discordant for multiple sclerosis. Report of one pair and discussion of possible causes of multiple sclerosis.

One pair of male monozygous twins was examined: only 1 twin had multiple sclerosis. Differences in the life histories of the twins were identified. Haematological, biochemical and microbiological studies were performed. It is possible in theory to determine which environmental factors may have been responsible for the development of multiple sclerosis in 1 twin. Several differences in life history were found in this study.

Unusual manifestations of herpes zoster. A clinical and electrophysiological study.

The literature on complicated herpes zoster is summarized in this paper. The case histories of 18 patients with herpes zoster are presented. Two patients had encephalitis, 2 had myelitis and the other 14 patients had various types of lower motor neurone disturbance. Both patients with encephalitis--one of who developed choreo-athetosis during the illness--recovered fully. Only 1 of the 2 patients with myelitis recovered fully; the other remains severely paraparetic and the reason for her incomplete recovery may be related to the presence of generalized arteriolar disease associated with seronegative rheumatoid disease. One patient developed a Guillain-Barre syndrome 3 weeks after the onset of herpes zoster. Recovery in the 15 patients with lower motor neurone involvement has been slow butcomplete--or almost complete--in all but 1, a patient with persistent facial weakness as part of the Ramsay Hunt syndrome and who also had weakness of one upper limb. Seven other patients had lower limb weakness. In 2 patients the weakness was confined to abdominal myotomes and 2 other patients had urinary retention. Electromyographic abnormalities were found in the muscles which were weak and frequently also in muscles which appeared strong. It is emphasized that neurological disturbances other than sensory abnormalities may be found in patients with herpes zoster. Motor complications of various types are not uncommon.

Who was... Frank Buckland?

Frank Buckland introduced salmon and trout to Australia. He was also one of the most popular writers on natural history in the 19th century and this interest, particularly in fish farming, rapidly overtook his work as a doctor.

Transient ischaemic attacks: a retrospective study of 43 cases.

Forty-three Caucasians with transient ischaemic attacks (TIAs), all age- and sex-match controlled, were retrospectively studied. There was no difference in sex distribution. The peak age for TIAs was 55-64. The haematocrit and cholesterol levels of men were significantly elevated (0.01 greater than P greater than 0.001 for haematocrit, and 0.01 greater than P greater than 0.001 for cholesterol). Six patients were controlled hypertensives but in general there was no significant difference in the blood pressures of patients and controls. The risk factors for TIAs and strokes are discussed.

Robert Lawson (?1846-1896).

Various descriptions of what would now be called Korsakoff Syndrome may be found in the medical literature predating the eponymous reports of Sergei Korsakoff (1854-1900) that date from 1887 onwards. Of these, it has been stated that the "most promising account" (Draaisma in Disturbances of the mind 163-164, 2009) may be that of Dr. Robert Lawson, published in 1878 in the journal Brain in its inaugural year of publication (Lawson in Brain 1:182-194, 1878). As Lawson is likely to be an unfamiliar name to most neurologists, and does not appear in the Oxford Dictionary of National Biography, we offer this brief account of his life and work.

A comparison of an anterior jaw lift manoeuvre with the Berman airway for assisting fibreoptic orotracheal intubation.

This study compared the efficacy of an anterior jaw lift manoeuvre with that of the Berman airway in clearing the upper airway during oral fibreoptic tracheal intubation in anaesthetised, paralysed patients. Fifty patients were randomly assigned to undergo fibreoptic-assisted intubation with one method, followed by crossover to the alternative method. The time taken to view the vocal cords was the primary endpoint, and we also noted the rate of failure to view the cords, i.e. cords not seen after 120 s of endoscopy. Anterior jaw lift yielded significantly shorter times to view the vocal cords (median [interquartile range; range]: 22 [17-46; 7-120] s vs 40 [29-67; 21-120] s, p = 0.001) and a higher success rate (49/50 vs 42/50, p = 0.014). We conclude that the anterior jaw lift is more effective than the Berman device for achieving airway clearance in this setting.

Anterior interosseous nerve palsy: spontaneous recovery in two patients.

The case histories of two patients who developed an anterior interosseous nerve palsy apparently as a result of an external pressure injury are reported. Both patients recovered fully without surgical exploration, one 19 months and the other nine months after the onset. It is stressed that complete recovery may occur spontaneously.

McArdle's disease--what limit to the age of onset?

A patient with McArdle's disease is reported in whome proximal muscle weakness began in the 7th decade. Other unusual features included the absence of muscle cramps at any stage, asymmetrical wasting of the shoulder girdle muscles and calf hypertrophy. Muscle biopsy revealed a vacuolar myopathy, absent phosphorylase staining and qualitatively low glycogen content.

Intractable epilepsy.

A 26-year-old female had her first partial seizure at the age of five years. Further seizures occurred and later became generalised in nature. Control of the seizures became difficult despite the use of nine different anticonvulsants over a period of 20 years. She was not suitable for neurosurgical intervention because of the diffuse nature of her seizures. Cerebellar stimulation had only a marginal effect on seizure frequency. With time she became mentally retarded and was unable to benefit from formal education. Her illness demonstrates many of the long-term clinical features and management problems of intractable epilepsy.

The Cotard syndrome. Report of two patients: with a review of the extended spectrum of 'délire des négations'.

The Cotard syndrome is characterized by the delusion where an individual insists that he has died or part of his body has decayed. Although described classically in schizophrenia and bipolar disorder, physical disorders including migraine, tumour and trauma have also been associated with the syndrome. Two new cases are described here, the one associated with arteriovenous malformations and the other with probable multiple sclerosis. The delusion has been embarrassing to each patient. Study of such cases may have wider implications for the understanding of the psychotic interpretation of body image, for example that occurring in anorexia nervosa.