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.

Explorando el oscuro continente: imagen médica y cerebro / Exploring the dark continent: medical image and brain

Introducción. Hasta finales del siglo XIX, el sistema nervioso central es prácticamente inaccesible a la observación directa. El descubrimiento en 1895 de los rayos X y su posterior aplicación médica constituyen un cambio de paradigma que revoluciona por completo la manera en que se practica la neurología. La posibilidad de visualizar el interior del encéfalo tiene un impacto mayúsculo en la práctica clínica y enriquece el diagnóstico y el tratamiento de patologías cerebrales de una forma hasta entonces inimaginable. Desarrollo. El propósito de este trabajo es describir el nacimiento y el desarrollo de la imagen médica cerebral: partimos del descubrimiento de los rayos X y del inicio de la radiografía hasta llegar a la aparición en la década de los setenta de la tomografía computarizada y la resonancia magnética, técnicas que cambiarían el mundo del diagnóstico por imagen. En este breve recorrido por la historia de la neurorradiología también se incluye el origen de la angiografía y otras técnicas actualmente en desuso, pero que en su momento constituyeron una auténtica revolución; tal es el caso de la ventriculografía o la neumoencefalografía. Conclusiones. Los procedimientos y técnicas descritos en este artículo han permitido visualizar el interior del cerebro, facilitando el diagnóstico y el tratamiento de múltiples procesos neurológicos (AU)

Introduction. Until the late 19th century, direct observation of the central nervous system was practically impossible. The discovery of X-rays in 1895 and their subsequent application in the field of medicine brought about a shift of paradigm that completely revolutionised the way in which neurology was practised. The possibility of viewing the inside of the brain had a pronounced impact on clinical practice, and enriched the diagnosis and treatment of brain pathologies in a manner that was unimaginable up until then. Development. The aim of this study is to describe the birth and development of medical imaging of the brain, from the discovery of X-rays and the early days of radiography to the appearance of computerised tomography and magnetic resonance in the 60s, both of which are techniques that were to change the world of diagnostic imaging forever. This brief overview of the history of radiology also includes the origins of angiography and other techniques that are no longer in use, but which were ground-breaking innovations in their time, such as ventriculography or pneumoencephalography. Conclusions. The procedures and techniques described in this article made it possible to view the inside of the brain, thereby facilitating the diagnosis and treatment of a number of neurological processes (AU)

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.

A propósito de los ochenta años del descubrimiento de Egaz Moniz de la angiografía cerebral / apropos of the eighty years of the Egaz Moniz discovery of the cerebral angiography

Antonio Caetano de Abreu Freire Egas Moniz en 1963 publicó el procedimiento quirúrgico de la leucotomía profrontal como un tratamiento radical de las enfermedades mentales. El comité del Premio Nobel le concedió el reconocimiento en 1949 en Fisiología y Medicina. compartió el premio con Walter Rudolf Hess, neurólogo suizo, por sus aportes al conocimiento de la organización funcional del diencéfalo. Siendo la mayor contribución de Moniz el descubrimiento y desarrollo de la angiografía cerebral en 1927, hoy aún persisten las interrogantes de esta probable injusta decisión.(AU)

Evolución de la angiografía digital cerebral / Evolution of th digital cerebral angiography

Premio Nobel que fue reconocido por sus trabajos en tratamientos radicales en enfermedades mentales, pero no por la intervención de la angiografía, Antonio Caetano de Abreu Freire Egaz Moniz, se le acredita la inción de la angiografía. Sin embargo el impacto importante que tuvo en el desarrollo de este campo de la Medicina, que sobresali+o en sus trabajos, se le negó el Premio Nobel por circunstancias de la época. Por muchos años fue olvidada por parecer una técnica misteriosa. Hoy en día continúa cumpliendo un importante rol en el campo de la medicina vascular. La radiología se inicia como disciplina en los años treinta del siglo veinte, cuando se crea la Sociedad Norteamericana de Radiología, la cuál impulsa la relación entre enfermedad e imagen. La neurorradiología, inexistente como disciplina independiente, pertenecía a los clínicos, unos pocos la adoptaron como una discilplina comenzando con el estudio sistematizado de la anatomía y procesos patológicos del sistema nervioso a través de la imagen. Esta se desarrolla vertiginosamente en Suecia, particularmente en en Instituto Karolinska de Estocolmo, y en Nueva York. La neurorradiología atribuible a Word en los albores de los años cincuenta, se concreta por el Dr. Juan M. Taveras en 1955, en la Universidad de Nueva York. Este artículo, refleja el comienzo de la angiografía, con Egas Moniz, y su evolución en el tiempo.(AU)

[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.