Ipsilateral hemiparesis: the forgotten history of this paradoxical neurological sign.

OBJECTIVE: Establishing the neurological localization doctrine for the contralateral hemispheric control of motor functions in the second half of the 19th century, researchers faced the challenge of recognizing false localizing signs, in particular paradoxical or ipsilateral hemiparesis (IH). Despite tremendous progress in current methods of neuroradiological and electrophysiological exploration, a complete understanding of this phenomenon has yet to be attained. METHODS: The authors researched the well-described cases of hemiparesis/hemiplegia ipsilateral to an intracranial lesion published in the scientific literature in the pre-MRI era (before 1980). A comprehensive review of the physiopathological mechanisms proposed for paradoxical hemiparesis throughout this period, as well as the pathological evidence substantiating them, is provided. RESULTS: A collection of 75 patients with hemiparesis/hemiplegia ipsilateral to the primary intracranial lesion reported between 1858 and 1979 were eligible for analysis. Most cases occurred in adults with supratentorial, slowly developing, extraparenchymatous mass lesions, such as neoplasms (38%) or chronic subdural hematomas (36%). Physiopathological theories proposed by the neurologists who investigated IH can be grouped into 4 major concepts: 1) lack of anatomical decussation of the corticospinal tract; 2) impaired functional activation of the contralateral hemisphere by the lesioned dominant hemisphere through the callosal connections; 3) Kernohan's notch phenomenon, or mechanical injury of the contralateral cerebral peduncle against the free edge of the tentorium; and 4) cerebrovascular dysfunction involving the contralateral hemisphere owing to kinking and mechanical flattening of the carotid artery contralateral to the primary intracranial lesion. CONCLUSIONS: IH represents a still underdiagnosed paradoxical neurological phenomenon. With the aid of modern neuroradiological and neurophysiological methods, Kernohan's peduncle notch mechanism has been confirmed to cause IH in many of the cases reported in recent decades. Nevertheless, alternative functional and/or vascular mechanisms must be investigated further for unexplained IH cases, in particular for transitory IH without evidence of peduncle injury. The historical theories reviewed in this paper represent a conceptual framework that may be helpful for this purpose.

Jean-Alexandre Barré (1880-1967): his detection sign of subtle paresis due to pyramidal deficit (1919) and his work in line with that of Giovanni Mingazzini (1859-1929).

This is a paper about the development of a sensitive examination of subtle motor pyramidal deficits. Jean-Alexandre Barré's life and work are reappraised, and also his milieu prone to increase his clinical skillfulness and sharping many motor maneuvers on subtle motor deficits (1919, 1920, 1937). Giovanni Mingazzini is also remembered by his precursor publication of "small signs" about organic paresis (1913), and by his neuroanatomical background, in an Italian Neuropsychiatric milieu, at the time.

Henrik Ibsen's Battle with Cerebrovascular Disease.

Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday celebration that he intended to continue writing. His last play, When We Dead Awaken, was published in 1899. Why did Ibsen's dramatic writing come to an end? This chapter presents a medical account of Ibsen's health condition during the last 6 years of his life. It is based on a review of a document written by one of his doctors, Edvard Bull (1845-1925), letters, biographic information, and Ibsen's death certificate. The historical material suggests that he suffered from arteriosclerosis and cerebrovascular disease, and that he suffered several strokes, in 1900, 1901, and 1903. He suffered a paresis in his left foot, expressive aphasia, and a right hemiparesis, and he lost the ability to write. There is no evidence that Ibsen was hospitalised. He received medical treatment and care at his home and at a recreational spa. His health condition was unstable, and it is likely that he suffered from a series of smaller strokes in the last years of his life. Ibsen developed signs of heart failure, and he died peacefully from "paralysis cordis" at his home on May 23rd, 1906.

Perspectives of Medieval Persian Medicine on Multiple Sclerosis.

INTRODUCTION: Traditional Persian Medicine (TPM) was the prevailing practice of medicine in the Eurasia region up through the 18th century, a practice of medicine stemming back to Hippocrates and to the 5000 year old civilization of the region. It is a school of medicine which touches on many a delicate points which may seem unimaginable within the realm of modern allopathic medicine. This practice of ancient medicine besides shedding light on various possible theoretical modern day disorders serves as a vast resource for therapeutics. In this paper, we present study of the manuscripts of this ancient medical practice in search of symptom presentations coinciding with presentation of multiple sclerosis (MS). MATERIAL & METHOD: This paper represents a comprehensive search through TPM texts and manuscripts with the intention to seek possible clues on MS from potentially valuable age-old resources. We predominantly focused our search on the works of five eminent physicians of Medieval Persia: Avicenna (980-1037 AD), Haly Abbas (949-982 AD), Rhazes (865-925 AD), Averroes (1126-1198 AD) and Jorjani (1042-1137 AD). RESULTS: In this paper, the authors attempt a theory and conclude with high probability that a conjunction of a series of signs, symptoms found in TPM texts under the terms khadar, isterkha and falej form the symptoms and the disease pattern of modern day MS. This theory draws upon existent similarities in terms of disease pathology, disease patterns and predisposing factors seen between MS and the related morbidities within Persian Medicine. CONCLUSION: We recommend further examinations of such potentially valuable long-standing resources, examining the diagnoses and treatments as set forth by Persian Medicine through international collaboration within the global scientific community.

Johan Georg Raeder (1889-1959) and paratrigeminal sympathetic paresis.

INTRODUCTION: Johan Georg Raeder (1889-1959) was the most eminent Norwegian ophthalmologist in the early decades of the last century. Raeder made significant contributions to our current understanding of glaucoma. He is remembered for a syndrome he described, that of trigeminal nerve neuralgia and/or paresis and incomplete Horner's syndrome (oculopupillary sympathetic paresis). DISCUSSION: Here, Raeder's biography, scientific contributions, and a thorough review of his original report on paratrigeminal sympathetic paresis are presented. Raeder's syndrome may reflect a lesion of the middle cranial fossa, which involves oculopupillary sympathetic fibers that originate from the internal carotid artery plexus and travel with the trigeminal and oculomotor nerves.

Hans von Bülow: creativity and neurological disease in a famous pianist and conductor.

Hans von Bülow (1830-1894) was a conductor and pianist of worldwide reputation and founder of many stylistic interpretations of classic and romantic symphonies. The close friendship with Richard Wagner, but not the enthusiastic admiration of his dramatic musical opus, ended abruptly when Hans von Bülow became aware of the betrayal of his wife Cosima and Richard Wagner. Hans von Bülow reported symptoms and signs of neurological disease in many letters that were kept and edited by his second wife Marie. For decades he suffered from chronic neuralgiforme headaches, which were caused by a tumor of the cervical radicular nerves. At the age of 45 years, he suddenly developed a motorsensory deficit in the right arm and hand and a contralateral facial deficit, suggestive of brainstem infarction. He recovered and celebrated even greater successes as a musician, although phases of major depression also interfered with his professional life. In the last, phase of his life, he experienced the consequences of generalized atherosclerosis and cerebral microangiopathy. It was a second cerebrovascular accident of the brainstem that caused his death, only 10 months after his last concert performance. Although his death occurred in Egypt, an autopsy was performed by Professor Ludwig Edinger and the results will be presented.

[Malariatherapy in Italy. A historical account of therapeutic inoculation of malaria parasites in Italian psychiatric clinics]. / La malariaterapia in Italia; un contributo alla storia dell 'inoculazione terapeutica della malaria nella clinica psichiatrica e neurologica.

For more than thirty years, from the early Twenties to the late Fifties, the inoculation of malaria parasites was the therapeutic treatment preferred by Western psychiatrists and neurologists for several clinical forms of tertiary syphilis, especially general paresis. During those decades, tens of thousands of people, mainly paretics but also schizophrenic patients, were intentionally infected with the human malaria parasites. In this paper we present the result of a bibliographic survey of the practice of malariatherapy in Italy. We analyzed the seven main Italian neurology and psychiatry journal from 1920 to the 1960. Moreover, we collected malariological bibliography concerning malariatherapy, and all the books on malariatherapy and chapter on this topic contained in any neurology and psychiatry textbooks published in Italy during the same period. We found 91 papers in the psychiatry journals. Most of these papers were concentrated between 1926 and the end of the Thirties; the main subject consisted of clinical-statistical information, but several papers concerned serological or anatomical alteration associated to the evolution of the disease and the therapy, and the mechanisms of action. Most articles discussed the criteria for defining recovery from general paresis obtained through malariatherapy. This historical and bibliographic review shows that malariatheapy was immediately accepted among Italian psychiatrists because of the strong relationship with Austrian and German psychiatric culture. The spread of the treatment was concentrated in the North and Center of Italy, and was administrated mainly in public psychiatric hospitals and university neurological clinics. Malariatherapy is a very interesting and fascinating subject the history of the interdisciplinary aspects related to the use of malariatherapy in psychiatry and malariology makes. This subject a unique probe for exploring in a very concrete way the evolution of several important and still topical clinical, biological and ethical issues of XXth century medicine.

Paresis, historical therapy in the perspective of Caelius Aurelianus, with special reference to the use of hydrotherapy in antiquity.

Caelius Aurelianus provides in his work Tardarum sive chronicarum passionum, based on Soranos' famous, but lost, work about acute and chronical illnesses, a remarkably detailed description of the physio-therapy of paresis, which covers the complete therapeutic spectrum of the groundwork of a combined therapy. His view that rehabilitative treatment should be started from the second day of illness sounds almost revolutionary. Also, modern early rehabilitation makes a specific use of combined therapy in a way that is analogous to that described by Caelius Aurelianus. Even today, the view is taken that fast mobilisation of the patient is the top priority of therapy. The three-stage mobilisation therapy involving exercises in rolling-in-bed as well as practice in trying-to-sit-up is quite similar to what is common practice today.

Dejerine's syndrome or Spiller's syndrome?

We report the difference existing between two clinical syndromes: Spiller's syndrome is caused by a complete involvement of the medial hemimedulla, while Déjérine's syndrome is determined by lesions restricted to the anterior portion of the medial hemimedulla and is characterized by hypoglossal nerve palsy and contralateral hemiparesis.

[Notes on the sources for the study of malariatherapy in Italy]. / Brevi note sulle fonti utilizzate per lo studio della malariaterapia in Italia.

The article presents the results of a critical evaluation of the clinical histories of 1240 cases of progressive paresis recorded in the S. Maria della Pieta (1911-1950) and reconstructs the scientific discussion about the results of malariatherapy and its action mechanism. The bibliographical study led to a regional characterization of the therapy in the scientific orientation and techniques. The authors are now working out the data, hoping for a future debate on the topic.

Research strategies in 'slow' infections in psychiatry.

The research processes in the elucidation of the causes of general paresis, the first slow infection in psychiatry, and of Kuru, the first slow virus infection in man, were considered. The errors and difficulties encountered may contribute to the formulation of research strategies for contemporary work on possible persistent infections with unknown viruses as a cause of psychiatric disorders. Clinical obsservation, bold hypotheses and methodological advances appear more valuable than diagnostic categorization in etiological research into psychiatric disorders. The low heuristic value of diagnosis is due to the lack of specificity of psychiatric symptoms and syndromes, especially in low grade organic disturbances.

[Wagner von Jauregg and development of malaria therapy]. / Wagner von Jauregg und die Entwicklung der Malariatherapie.

In this history of psychiatric therapy the progressive paralysis deserves special interest: for the first time an organic psychosis was treatable successfully by a procedure found by scientific methods. This article describes life and work of Julius Wagner, Ritter von Jauregg (1857-1940) and remembers the introduction of the malaria-therapy, which was developed by Wagner 75 years ago.

[Theo van Gogh's medical record]. / Het medische dossier van Theo van Gogh.

In the final months of his life Theo van Gogh was admitted to the 'Geneeskundig Gesticht voor Krankzinnigen te Utrecht'. In November 1990 from the archives of the Willem Arntsz Huis, psychiatric centre in Utrecht, the medical files from this period were made available and a transcription was made by Han van Crimpen and Sjraar van Heugten, scientific collaborators of the Van Gogh Museum. From these data it is acceptable to conclude that Theo van Gogh had dementia paralytica and suffered a fast deterioration of his situation in these last few months. It is, however, probable that at least as early as 1886 Theo showed the first symptoms of this disease when he was in Paris, and that he was treated for this reason by dr. Rivet and dr. Gruby. There are insufficient indications that in Vincent van Gogh's case the same diagnosis can be put forward. It is most probable that during Vincent's visit to Theo in Paris in July 1890 in Theo's case symptoms of his medical deterioration were to be seen and this may have influenced the considerations finally leading to Vincent van Gogh's suicide.

Julius Wagner von Jauregg: a reappraisal.

A little more than half a century has passed since the death of Julius Wagner von Jauregg, a significant figure in the history of modern psychiatry. We believe that after this passage of time the life and work of Wagner von Jauregg deserve reappraisal.