C. Miller Fisher and the Comatose Patient.

Neurologic examination of the comatose patient has gradually matured. Less than 50 years ago, neurological examination in coma became a regular part of textbooks with separate chapters devoted to the topic but many were deficient in detail. In 1969, C.M. Fisher published an extraordinary 56-page paper on the examination of the comatose patient. The paper-one of Fisher's gems-is not well known and infrequently cited. The many new observations collected in this comprehensive paper are reviewed in this vignette, which highlights not only how these contributions shaped our thinking on coma but also questioned shaky concepts.

How tandem gait stumbled into the neurological exam: a review.

Tandem gait testing is an integral part of the neurological exam. It is informative in a wide variety of disorders ranging from cerebellar disease to vestibular and peripheral neuropathies, parkinsonism, and other neurodegenerative conditions. We discuss the history and development of tandem gait testing as well as its technique, utility, and limitations in the assessment of neurological conditions. Tandem gait has emerged as a tool in the assessment of cerebellar disease, Huntington disease, idiopathic Parkinson's disease, atypical parkinsonism, peripheral neuropathies, and vestibulopathies. Its origin can be deduced from experimental observation and clinical experience as far back as the early nineteenth century. Despite the long history and ubiquitous performance of tandem gait testing, there is no standardized, guideline-based protocol to model for more homogenous research and clinical practices. Such a protocol should be developed using historical texts and manuscripts as well as the consensus of the medical research community. With standard protocols, further studies could define the sensitivity of abnormal tandem gait testing in cerebellar disorders, more diffuse neurodegeneration, and peripheral pathologies. Tandem gait can be a useful marker of dysfunction in neurologic conditions whose pathologies extend beyond the vermis or vestibulocerebellar module to include interconnected networks throughout the nervous system.

Deep tendon reflex: The background story of a simple technique.

Wilhelm Erb and Carl Otto Westphal from Prussia first described the knee jerk in the same issue of the journal Archiv für Psychiatrie und Nervenkrankheiten in January 1875. This article retraces the history of development of 'deep tendon reflex' as an integral clinical sign during every neurological examination. The history of the evolving shapes of the reflex hammer, the iconic trademark and the ultimate signature of a neuroscientist, is also presented.

A tribute to Wartenberg's refined neurological examination.

Robert Wartenberg was a renowned 20th century neurologist who contributed greatly to our understanding of the neurological examination. This article aims to illustrate his legacy by highlighting five seminal neurological signs.

A tribute to Wartenberg's refined neurological examination / Um tributo ao refinado exame neurológico de Wartenberg

ABSTRACT Robert Wartenberg was a renowned 20th century neurologist who contributed greatly to our understanding of the neurological examination. This article aims to illustrate his legacy by highlighting five seminal neurological signs.

RESUMO Robert Wartenberg foi um renomado neurologista do século XX que contribuíu enormemente para o entendimento do exame neurológico. Este artigo tem como objetivo principal ilustrar seu legado, ressaltando cinco sinais neurológicos seminais.

Neurological examination: pioneering authors and their books.

The objective of this article is to highlight some of the most important pioneering books specifically focused on the neurological examination and their authors. During the XIX Century, Alexander Hammond, William Gowers and Charles Mills pioneered the neurological literature, followed in the XX Century by Aloysio de Castro, Monrad-Krohn, Derek Denny-Brown, Robert Wartenberg, Gordon Holmes, and Russel DeJong. With determination and a marked sense of observation and research, they competently developed and spread the technique and art of the neurological exam.

On the origin of EDSS.

The origin of EDSS, the Expanded Disability Status Scale for multiple sclerosis, was some 30 years before its only publication in 1983 when we were trying to assess a potential treatment and found no published methods. Findings from the complete neurologic examinations in over 200 patients were consolidated into mutually exclusive but all-inclusive neurophysiologic entities called Functional Systems (FS), and these provided the basis for an 11 step 0-10 rank order scale, the Disability Status Scale (DSS). This was used successfully, as well as in the first two Class I treatment trials performed, with the second one also incorporating the 8 FS. Both measures were part of an assessment of a natural history series derived from men hospitalized for MS in the US Army in World War II and followed for some 20 years. Describing each of the 8 FS as affected (1) or normal (0) defined 256 possible patterns of involvement for all patients. Half the patients at diagnosis had one of the 14 most common patterns. Each FS worsened in frequency and severity of involvement in correlation with the DSS, which overall showed a unimodal distribution, until in another series of patients 16 years post onset bimodality first appeared. Observations that the 11 step DSS might have too few steps for treatment trials led to the EDSS of 20 steps with each grade between 1 and 9 divided into two. The system of EDSS+FS to summarize all the CNS involvement as defined by objective findings on neurologic examination thereafter remained unchanged to the present. I just learned that the unpublished system copyrighted in Switzerland as "neurostatus" has been called and referenced as my EDSS. It is not.

[Sir William Richard Gowers: author of the "bible of neurology"].

William Richard Gowers is one of the great pioneers in neurology and the author of the well-known neurology textbook, "A Manual of Diseases of the Nervous System." His concepts of neurology are based on meticulously and carefully accumulated knowledge of history, observations, and neurological examinations of patients with various neurological diseases. He is not only a great neurologist but also a great teacher who loves teaching students and physicians through well-prepared lectures. We can glean the essence of the field of neurology through his life story and numerous writings concerning neurological diseases.

[Monrad-Krohn: a norwegian neurologist].

Monrad-Krohn was born in Bergen and is a representative of Scandinavian neurologists. From 1912 to 1917, he studied clinical neurology in Paris and London. During his stay there, he was intensely influenced by several eminent neurologists, such as Dejerine, Marie, Babinski, Souques, Horsley, Stewart, and Wilson. He fulfilled his duties as a professor of neurology at the University of Oslo (Rikshospitalet) for four decades. One of his students, Sigvald Bernhard Refsum, succeeded him in 1959. Monrad-Krohn was interested in reflexology, language, and facial innervation. A peculiar phenomenon, paradoxical emotional hypermimia, is known as the Monrad-Krohn sign. He also coined the word dysprosody as a definite neurological sign. His masterpiece "The Clinical Examination of the Nervous System" made him world famous. It had a great reputation as an outstanding textbook of neurological examination, was translated into many languages, and went through several editions.

[Robert Wartenberg: the neurologist, the teacher, and the man].

Wartenberg was born in 1887 in Grodno, old Lithuania (present-day Belarus). He received his medical degree from the University of Rostock in 1919, and worked at the University of Freiburg until 1935, when he immigrated to the United States to escape Nazi Germany. He then worked at the University of California, San Francisco, and was appointed Clinical Professor of Neurology in 1952. He died of a heart illness in 1956. Wartenberg wrote more than 150 papers on clinical neurology in German and English, especially on reflexes and signs. His books, "Examination of Reflex" and "Diagnostic Tests in Neurology" were translated into many languages, including Japanese. His contribution to the study of reflexes includes Wartenberg's reflex of the thumb, head dropping test in Parkinson's disease, necessity of differentiating abdominal muscle and abdominal skin muscle reflexes, and many others. He had knowledge, skill, art and ability enough to translate difficult problems into tangible methods of diagnosis and treatment. He tried to diagnose and treat patients quickly, with minimum laboratory tests, and avoided invasive tests and expense of time and money. His efforts to provide patients with the best treatment in terms of time, safety, and cost, is the essence of medicine and is still worth practicing in modern neurology using advanced technology.

The history of examination of reflexes.

In the late 1800s, Wilhelm Erb, Joseph Babinski, William Gowers, and others helped develop the neurologic examination as we know it today. Erb was one of the first to emphasize a detailed and systematic neurologic exam and was co-discoverer of the muscle stretch reflex, Gowers began studying the knee jerk shortly after it was described, and Babinski focused on finding reliable signs that could differentiate organic from hysterical paralysis. These physicians and others emphasized the bedside examination of reflexes, which have been an important part of the neurologic examination ever since. This review will focus on the history of the examination of the following muscle stretch and superficial/cutaneous reflexes: knee jerk, jaw jerk, deep abdominal reflexes, superficial abdominal reflexes, plantar reflex/Babinski sign, and palmomental reflex. The history of reflex grading will also be discussed.

The history and future of neuro-otology.

PURPOSE OF REVIEW: The field of neuro-otology has advanced substantially over the past 150 years. The function of the vestibular system was presumed to be audiologic prior to the groundbreaking work of Prosper Ménière in the late 1800s. Since that time, scientific discovery has advanced our knowledge of the physiology and the pathophysiology of the vestibular system. This article describes where we have been, where we are now, and where we need to go from here. RECENT FINDINGS: Some of the important recent advances include: (1) improved imaging of the brain and inner ear, (2) development of new eye movement recording and analysis techniques, (3) development of new tests of otolith function, (4) particle repositioning maneuvers for all types of benign paroxysmal positional vertigo, and (5) improved bedside diagnosis and treatment of vestibular neuritis. SUMMARY: The cause and treatment for some common neuro-otologic disorders is now well delineated. The diagnosis and management of less common disorders has improved as well. Future work is still required to advance the science of vestibular physiology and pathophysiology and ultimately to discover new ways to improve the health of patients with these disorders.

History of the 'geste antagoniste' sign in cervical dystonia.

The geste antagoniste is a voluntary maneuver that temporarily reduces the severity of dystonic posture or movements. It is a classical feature of focal and particularly cervical dystonia. However, the precise historical aspects of geste antagoniste still remain obscure. The goals of this review were (1) to clarify the origin of the geste antagoniste sign; (2) to identify the factors that led to its diffusion in the international literature; (3) to follow the evolution of that term across the twentieth century. We used medical and neurological French, German and English literature of the late nineteenth and early twentieth centuries, and the PubMed database by entering the terms geste antagoniste, antagonistic gesture and sensory trick. The geste antagoniste sign is a legacy of the Paris Neurological School of the end of the nineteenth century. The term was introduced by Meige and Feindel in their 1902 book on tics, written in the vein of their master, Brissaud, who first described this sign in 1893. The almost immediate translations of this book by Giese into German and Kinnier Wilson into English contributed to the rapid spreading of the term geste antagoniste, which is still in use worldwide today. The term antagonistic gesture is the translation proposed by Kinnier Wilson, which also led to the use of the term geste antagonistique. The geste antagoniste sign has long been considered a solid argument for the psychogenic origins of dystonia until the 1980s when Marsden made strong arguments for its organic nature.

Traumatic brain injuries in the ancient Egypt: insights from the Edwin Smith Papyrus.

BACKGROUND: Traumatic brain injury (TBI) is probably as old as human beings. The Edwin Smith Papyrus is the first treatise describing the treatment of patients with TBI and allows insights into the medical examination and treatment of head-injured patients in ancient Egypt. METHOD: Clinical, diagnostic, and therapeutic principles in the treatment of TBI in ancient Egypt were analyzed. RESULTS: Methodically, cases and the presentation of each case are neatly classified within the papyrus. The papyrus contains the first description of the brain, pulsations, contusions as the result of TBI, the dura, and cerebrospinal fluid, revealing a more or less sophisticated knowledge of cerebral anatomy. Furthermore, ancient physicians examined wounds, fractures, signs of basal skull fractures, and associated neurological or infectious symptoms, and classified the injury pattern according to their prognosis. Therapeutic options at this time seemed to have been limited. CONCLUSIONS: The Edwin Smith Papyrus reveals astonishing observation skill when considering the methods and limits of ancient times. These physicians were able to recognize many symptoms of TBI and assign them a prognostic value.