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This publication reviews the steps in the path towards obtaining a complete image of the brain. Up to the 1920s, plain X-ray films could demonstrate only calcified tumors, shifts in midline position of a calcified pineal gland due to a mass in the cranium, or foreign metallic objects within the skull. Walter Dandy reported in 1918 that he visualized cerebral ventricles by introducing air as a contrast agent through a trocar into one of the occipital lobes or the right frontal horn of the ventricular system. Dandy localized lesions that distorted or shifted the ventricles. In 1920, Dandy placed air by lumbar puncture into the spinal subarachnoid space that could visualize the brain and entire ventricles. Antonio Egas Moniz with the assistance of his neurosurgeon colleague, Almeida Lima, obtained X-ray images of cerebral arteries of dogs and decapitated human heads from corpses after injecting strontium bromide into their carotid arteries. Satisfied by these experiments, Moniz injected strontium bromide directly into carotid arteries of five patients which failed to show intracranial vessels. In the sixth patient, intracranial arteries were outlined but that patient died of cerebral thrombosis presumably due to the hyper-osmolality of that contrast agent. Finally, on June 18, 1927, Moniz injected 22% sodium iodine into a 20-year-old man and obtained clear visualization of his carotid artery and intracerebral branches after temporarily occluding the artery with a ligature. Direct percutaneous puncture of the cervical carotid artery remained the primary technique unto the 1960s to visualize intracranial blood vessels until Seldinger’s technique was introduced in 1953. Computerized axial tomography (CAT) and magnetic resonance imaging (MRI) replaced cerebral arteriography for localizing tumors and epidural or subdural hemorrhage. However, angiography is used currently for embolization of aneurysms and removal of thrombi or emboli in patients with acute stroke.

Alice in Wonderland syndrome is a disorienting neurological condition that affects human perception to the senses of vision, hearing, touch, sensation, and the phenomenon of time. Individuals affected with Alice in Wonderland syndrome can experience alterations in their perception of the size of objects or their own body parts, known as metamorphopsias. It is known to occur in conditions including migraine, epilepsy, and certain intoxicants and infectious diseases. The name refers to Lewis Carrol's well-known children's book Alice's Adventures in Wonderland, in which the title character experiences alterations of sensation in which she felt that her body had grown too tall or too small, or parts of her body were changing shape, size, or relationship to the rest of her body. The syndrome was described in 1952 by Caro Lippman, and given its name in 1955 by John Todd. The metamorphopsias characteristic of this condition are also sometimes referred to as Lilliputian hallucinations, a reference to the fictional island of Lilliput in the novel Gulliver's Travels, written by Jonathan Swift in 1726. As such, many literary and medical publications have roots in the description of this syndrome. The purpose of this review is to summarize the literary and historical significance of Alice in Wonderland syndrome, as well as to provide the reader with a medical overview of the condition.

Fredrick E. Batten defined the pathology of subacute combined degeneration and made seminal observations about myasthenia gravis, poliomyelitis, and infantile neuronal lipofuscinosis.Fredrick Eusta...

James Samuel Risien Russell, MD, FRCP was an Anglo-African experimental neurophysiologist, neuroanatomist, and astute clinical neurologist (see Figure 1). Russell was born in 1863 to a Scottish fat...

Introduction: Of the nearly 38 million people in the USA who receive statin therapy, 0.1-0.5% experience severe or life-threatening myopathic side effects. Methods: We performed a genome-wide association study (GWAS) in a group of patients with severe statin myopathy versus a statin-tolerant group to identify genetic susceptibility loci. Results: Replication studies in independent groups of severe statin myopathy (n = 190) and statin-tolerant controls (n = 130) resulted in the identification of three single-nucleotide polymorphisms (SNPs), rs9342288, rs1337512, and rs3857532, in the eyes shut homolog (EYS) on chromosome 6 suggestive of an association with risk for severe statin myopathy (P = 0.0003–0.0008). Analysis of EYS cDNA demonstrated that EYS gene products are complex and expressed with relative abundance in the spinal cord as well as in the retina. Conclusion: Structural similarities of these EYS gene products to members of the Notch signaling pathway and to agrin suggest a possible functional role in the maintenance and regeneration of the structural integrity of skeletal muscle. Muscle Nerve, 2011

We report a case of a patient with history of alcohol abuse, treatment for hepatitis C and repeated strenuous physical activity who developed severe muscle pain and weakness during statin therapy. The symptoms persisted after discontinuation of the drug. The diagnosis of myopathy was made clinically and by electromyography. As his symptoms persisted a muscle biopsy was performed which showed inclusions consistent with hyaline inclusions. Hyaline inclusion myopathy is discussed in the context of this case with review of the literature.

Neurology in the 1900s: 1900–1909 H. Richard Tyler, MD The first decade of the 20th century (1900–1909) saw dramatic changes and advances in virtually every aspect of neurology. The basic science framework for neurology was solidified by fundamental advances in neurophysiology, led by Sir Charles Sherrington and his collaborators. Equally important advances were made in the study of the histology and pathology of the nervous system by Cajal and others (Tables 1 and 2). The clinical spectrum of neurology was broadened and enriched by many contributions still remembered eponymously today (see Table 1). A very subjective and selective selection of additional landmark contributions in different fields of neurology are listed in Table 2. Prominent among these were the studies that led to Nobel Prizes for Pavlov in 1904 on digestive physiology and to Golgi and Cajal in 1906 for their work on the neuron theory. Few neurodiagnostic tests were available to clinicians in the first decade of the 20th century, with arteriog

Charles Karsner Mills (1845–1931), perfected methods to use electrical stimuli of the cerebral cortex of alert humans to localize sites of their seizures. Mills meticulously recorded the neurological examination of patients and then correlated those findings with their brain autopsies to localize functions in human brain and spinal cord. He described a form of transcortical motor aphasia and effective methods to rehabilitate aphasic patients. Mills wrote The Nervous System and Its Diseases .

Article abstract Before the discoveries of John Call Dalton, Jr., MD (1824–1889), innervation of laryngeal muscles, long-term effects of cerebellar lesions, and consequences of raised intracranial pressure were poorly understood. Dalton discovered that the posterior cricoarytenoid muscles adducted the vocal cords during inspiration. He confirmed Flourens’ observations that acute ablation of the cerebellum of pigeons caused loss of coordination. Dalton observed that properly cared for pigeons gradually recovered “coordinating power.” Dalton observed that prolonged raised intracranial pressure caused tachycardia and then fatal bradycardia in dogs. Before Dalton published his photographic atlas of the human brain, neuroanatomy atlases were sketched by Europeans and imported into the United States. Dalton’s atlas of the human brain contained precise photographs of vertical and horizontal sections that equal modern works. Before Dalton introduced live demonstrations of animals, physiology was taught by recitation of texts only. Dalton was the first American-born professor to teach physiology employing demonstrations of live animals operated on under ether anesthesia. He wrote an essay advocating experimentation on animals as the proper method of acquiring knowledge of function and that humane animal experimentation would ultimately improve the health of man and animals. His eloquent advocacy for humane experimental physiology quelled attacks by contemporaneous antivivisectionists. Dalton was America’s first experimental neurophysiologist.

A 74-year-old man had diplopia, painful right ophthalmoplegia, proptosis, conjunctival injection, and facial skin lesions. Magnetic resonance imaging (MRI) revealed infiltration of the right intraorbital adipose tissue. Lesions were mixed low- and high-signal on T2-weighted images and enhanced on fat-suppressed T1-weighted postcontrast images. A skin biopsy revealed numerous noncaseating granulomas consistent with sarcoidosis. Treatment with corticosteroids and chlorambucil led to a full clinical recovery. Sarcoidosis should be considered in the evaluation of orbital pseudotumor in elderly patients, even if no systemic manifestations of sarcoidosis are present.

We compared the activity of Ib spinal interneurons in five patients with progressive supranuclear palsy (PSP) with six age-matched control subjects. Stimulation of the medial gastrocnemius nerve at motor threshold intensity activated Ib afferents that in turn inhibit H reflexes from the soleus muscle. Maximum inhibition occurred at interstimulus intervals of 6 and 8 ms for both control subjects and PSP patients and was significantly greater in the PSP patients. Increased Ib activity of PSP patients may be caused by loss of inhibition of Ib interneurons through degeneration of the medullary reticulospinal pathway. The corticospinal pathways, unopposed by the medullary reticulospinal tract, may excessively activate Ib interneurons.

ROSWELL PARK, M.D., (1852-1914) is remembered for founding the world's first cancer institute that now bears his name a century ago, The Roswell Park Cancer Institute, and for an unfortunate association with the mortal wounding of President William McKinley in Buffalo, NY, in 1901. Park's accomplishments as a pioneer American neurosurgeon have been overlooked. After Park was appointed as Chair of Surgery at the University of Buffalo in 1884, he became the first American surgeon to precisely localize and remove a posttraumatic epileptic focus in the absence of external scars in 1886. Park introduced American physicians and surgeons to David Ferrier's research on localization of cerebral cortical function and Victor Horsley's techniques for extirpating epileptic foci. In 1895, Park became the first American surgeon to successfully treat spina bifida. In the same year, he wrote the first American monograph on surgery of the head. Park's case reports of successful operations on patients deemed almost incurable reveal boldness and ingenuity. Park's untimely death truncated a promising career.

Fine, Edward J. (2013): The Alice in Wonderland Syndrome. In: Finger, Stanley, Boller, François, Stiles, Anne (Eds): Literature, Neurology and Neuroscience: Neurological and Psychatric Disorders. Amsterdam: Elsevier: 143-156, ISBN: 978-0-444-63364-4, DOI: 10.5281/zenodo.1038314, {"references":["Abraham, H.D., Aldridge, A.M., 1993. Adverse consequences of lysergic acid diethylamide. Addiction 88, 1327-1334.","Augarten, A., Aderka, D., 2011. Alice in Wonderland syndrome in H1N1 influenza. A case report. Pediatr. Emerg. Care 27, 120.","Berlin, M., Carlsen, J., Norseth, T., 1975. Dose dependence of methylmercury metabolism. Study of the distribution, biotransformation and excretion in the squirrel monkey. Arch. Environ. Health 30, 307-313.","Binalsheikh, I.M., Greisemer, D., Wang, S., Alvarez-Altafelf, R., 2012. Lyme neuroborreliosis presenting as Alice in Wonderland Syndrome. Pediatr. Neurol. 46, 185-186.","Blau, J.N., 1998. 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We bring to reader's attention the book Medical-Moral Account of the Most Troublesome and Rigorous Illness of Epilepsy, written in 1754 by the Mexican physician Pedro de Horta. This book is the earliest text on epilepsy written in the New World. We examine Pedro de Horta's medical and religious concepts of epilepsy and analyze concepts of epilepsy in Hispanic communities during the eighteenth century.

Gordon Morgan Holmes, MD, MRCP was an Irish born neurologist who received his medical education at Trinity College, Dublin, Ireland. He was trained in neuroanatomy and neuropathology at the Senckenberg Institute, Frankfort-Am-Main by Ludwig Edinger. He then returned to serve as a Registrar (House Officer) mentored by Richard Gowers and John Hughlings Jackson at the National Hospital, Queen Square, London. He collaborated with Thomas Granger Stewart in describing the loss of recoil in patients with cerebellar hemispheric tumors in 1904. Volunteering in 1914 for frontline hospital duty, he examined soldiers who had injuries to their occipital area causing hypotonia, dysmetria, staggering gait, and falling to the side ipsilateral to their injured cerebellar hemisphere. Holmes discovered that increasing the pace of the finger-nose manuever and applying slight resistance to a moving limb attenuated the dysmetria. Continuing observation of these patients afforded him to describe the evolution of their injuries to include increasing tremor and decreasing hypotonia. Holmes first attached levers to the limbs of hispatients to record their movements on a moving smoked paper kymograph. In 1939 he published photograh tracings made by low mass minature light bulbs attached to ataxic limbs that showed thehpometira and hypometria of their movements ipsilateral to their damaged cerebellar lobes. Holmes made sigficant contributions to understanding of the physiology of the human cerebellum.

• Although neither a physician nor a scientist, William Pryor Letchworth significantly improved the care and treatment of epileptics at the beginning of this century. As commissioner of the New York State Board of Charities and later president, he established Craig Colony, America's first comprehensive epilepsy facility. In Care and Treatment of Epileptics , he summarized contemporary medical and social knowledge of epilepsy. As cofounder and president of the National Association for the Study of Epilepsy, he introduced from Europe his improvements of the colony plan of construction and financed Transactions , the society's scholarly journal. He combined a sensitivity to the needs of the unfortunate with the resolve of a successful businessman. Although William Pryor Letchworth is remembered for his philanthropy and the park in western New York that bears his name, his signal contributions to modern concepts of epilepsy are unknown to most physicians. This article will acquaint readers with the life and accomplishments of this philanthropist and pioneer epileptologist.

In 1892, Frederick Peterson described the experiences of humans exposed to magnetic fields of strength comparable to those currently used in magnetic resonance imaging. These investigations were conducted in the Edison Laboratory. None of the subjects exposed to constant and to time-variable magnetic fields suffered any ill effects. Peterson concluded that the human organism was in no way appreciably affected by the most powerful magnets known to nineteenth-century science. Peterson can be credited with the first truly scientific assessment of the biological effects of high-intensity magnetic fields. His experiments on humans, done one century ago with great cogency and skill, provide a source of inspiration to modern studies on magnetic resonance imaging.

Publisher Summary This chapter reviews the origins of neurological examination. Neurological examination developed as a physiological analysis of patients' functions. The findings were linked to anatomy by post-mortem pathology and by a lesser extent to physiological experiments with animals. Correlation of signs and symptoms with specific pathologies guided the development of logical differential diagnoses. This list of diagnostic possibilities focused the investigation and reduced the need for definitive but highly invasive tests, such as myelography or pneumoencephalography, up to the development of computerized tomography (CT) or magnetic resonance imaging (MRI). Neurological examination permits interpretation of anatomical abnormalities revealed by MRI and CT of the brain and spinal cord. Rapid spiral CT without contrast now affords diagnosis of cerebral hemorrhage within minutes. MRI with ever-increasing varieties of scanning modalities and strength magnetic flux at 3T or greater will improve definition of lesions but cannot directly identify the disease or provide any information about function. Hence, technology will not supplant neurological examination.

• From biblical times to 1886, tremors were partially characterized by patterns of activation and associated disease states. William Richard Gowers and Frederick Peterson devised methods to determine the frequencies of the tremors of Parkinson's disease, alcoholism, hysteria, and other diseases. Their values concur closely with the contemporary ranges of 4.0 to 7.0 Hz in Parkinson's disease and 8.1 to 11.0 Hz in chronic alcoholism. This review properly credits these authors' pioneer investigations made with simple instruments a century ago.

This American pioneer of neurosurgery and cerebral localization was born in Philadelphia, Pennsylvania on January 19, 1837. He entered Brown University in Providence, Rhode Island at age 18. He was...

Background Oculomotor nerve paresis may have relatively benign but also life-threatening causes. Distinguishing between these is of great clinical importance. Objective To reveal a potential pitfall of the clinical evaluation of oculomotor nerve paresis. Patient Single case observation. Results A 56-year-old man had fluctuating diplopia and fatigable ptosis, promptly relieved by intravenous edrophonium, leading to the diagnosis of ocular myasthenia gravis. His pupillary function was intact. A few days after the initial diagnosis, he suffered a subarachnoid hemorrhage secondary to the rupture of a basilar artery aneurysm. His ocular symptoms were related to aneurysmal oculomotor nerve compression. Conclusion Patients with oculomotor nerve dysfunction need more detailed evaluation because the underlying cause cannot be safely determined on a clinical basis.

(2003). An American Pioneer Neurosurgeon and Medical Historian. Journal of the History of the Neurosciences: Vol. 12, No. 1, pp. 55-55.

The two most common phenotypes of X-linked adrenoleucodystrophy are the childhood cerebral form and adrenomyeloneuropathy, which occurs mainly in adults and affects the long tracts in the spinal cord most severely.1 Most patients with the cerebral forms have an inflammatory demyelinating process, while the principal pathology of adrenomyeloneuropathy is a non-inflammatory distal axonopathy, although 30% of patients with adrenomyeloneuropathy also develop some degree of inflammatory brain pathology.2 All forms of X-linked adrenoleucodystrophy are caused by a defect in the gene ABCD1 which codes for the peroxisomal membrane protein ALDP and is associated with the abnormal accumulation of very long chain fatty acids. Most patients with X-linked adrenoleucodystrophy have primary adrenocortical insufficiency. Although adrenal hormone treatment is considered mandatory and may be life saving, most investigators have expressed the opinion that it does not alter neurological status. We report a patient with a variant of adrenomyeloneuropathy in whom adrenal hormone replacement therapy improved neurophysiological function and clinical status. A 39 year old man was evaluated for adrenoleucodystrophy at the Kennedy–Krieger Institute (KKI) in 1985, because his nephew had been diagnosed with childhood onset adrenoleucodystrophy. The nephew died aged nine years and had necropsy confirmation of the diagnosis. Our …

The cerebellar examination evolved from observations of experimental lesions made by neurophysiologists and clinical descriptions of patients with trauma to the cerebellum. At the beginning of the 19th century, neurophysiologists such as Luigi Rolando, Marie-Jean-Pierre Flourens, and John Call Dalton, Jr. ablated portions of the cerebellum of a variety of animals and observed staggering gait, clumsiness, and falling from side to side without loss of strength. They concluded that the cerebellum coordinated voluntary movements. In 1899, Joseph Francois Felix Babinski observed that patients with cerebellar lesions could not execute complex movements without breaking down into their elemental movements and described the defect as dysmetria. In 1902, Babinski coined the term dysdiodochokinesis to describe the inability to perform rapid execution of movements requiring alternate contractions of agonist and antagonist muscles. Gordon Holmes in 1904 described the phenomena of rebound, noting that if a limb ipsilateral to a cerebellar lesion is suddenly released from tension, the appendage will flail. In 1917, Gordon Holmes reported hypotonia and dysmetria in men wounded by gunshot wounds to their cerebellum. These observations were rapidly included in descriptions of the cerebellar examination in popular contemporaneous textbooks of neurology. Modern observations have demonstrated that the cerebellum influences such cognitive functions such as planning, verbal fluency, abstract reasoning, prosody, and use of correct grammar.

Panzer divisions of the Nazi German Reich invaded Europe in blitzkrieg attacks. British forces, assisting beleaguered French armies, narrowly escaped capture by a heroic retreat from Dunkirk, France. War suspended awarding all Nobel Prizes and organizing international congresses in occupied countries. In the United States, isolationists attempted to keep the country out of World War II; a beguiling tranquillity lulled America until Japanese air forces attacked Pearl Harbor on December 7, 1941. 1 Neurology was there.

The subject of this “Neurognostic Question” was Henry Pickering Bowditch (Fig. 1), who was born in Boston in 1840. He was the son of a successful businessman, and the grandson of Nathaniel Bowditch...

Craig Colony in Sonyea, New York, was America's first comprehensive public epilepsy center. The background to its establishment (the first patients were admitted in 1896) and its role as a model for other institutions is described. The history of the first 25 years of the Colony is recounted and the contributions to epileptology, and the legacy to health care, of the founders ‐ William Pryor Letchworth, Frederick Peterson, Roswell Park, William P. Spratling and Frederick Munson ‐ are assessed.

Objective: To present the history of discovery of evoked potentials by reviewing the original publications of Caton, Beck, Dawson and Jewett. Background Caton9s publications revealed that unstimulated cerebral cortex had a positive charge and stimulation of an animal9s limb could produce waves of negative cortical currents in contralateral motor cortex. Design/Methods: Review of publications of Caton, Beck, Dawson and Jewett. Results: Richard Caton (1842-1926) discovered somatosensory evoked responses in 1875 Caton demonstrated fluctuations of a galvanometer connected to electrodes on exposed surfaces of rabbits9 cerebral cortex in response to stimulation of hind paws. Caton noted negative current fluctuations from occipital cortex after he shined light into retinas of rabbits. Adolph Beck in 1890 claimed primacy of discovery for similar observations. In 1947 Charles Dawson (1912-1983) superimposed amplified multiple cortical somatosensory evoked responses (SER) on a screen of an oscilloscope improving signal-to-noise ratio (SNR) of the SER. In 1954 Dawson developed the signal averager (SA) to further improve SNRs. Dawson9s SA consisted of a rotating switch driven by a motor that fed each individual scalp response to a single median nerve stimulus into 1 of 62 condensers. The SA serially discharged each condenser into an amplifier connected to a storage oscilloscope. Dawson noted that the superimposed SER had a onset latency of 28 ms. Dawson proved that SA could eliminate EEG waves not related to the stimulus. Dawson9s median SERs resembled modern cortical SERs. Conclusions: Caton should be credited as discoverer of evoked responses. Dawson should be considered founder of human evoked potentials research, because his averaging technique extracted the evoked potential. Disclosure: Dr. Fine has received personal compensation for activities with Slocum-Dickson Clinic. Dr. Fine holds stock and/or stock options in Bristol Myers-Squibb, Eli Lilly, Pfizer, and Johnson & Johnson. Dr. Riggins has nothing to disclose. Dr. Farooq has nothing to disclose.

Gordon Morgan Holmes, MD, MRCP was an Irish born neurologist who received his medical education at Trinity College, Dublin, Ireland. He was trained in neuroanatomy and neuropathology at the Senckenberg Institute, Frankfort-Am-Main by Ludwig Edinger. He then returned to serve as a Registrar (House Officer) mentored by Richard Gowers and John Hughlings Jackson at the National Hospital, Queen Square, London. He collaborated with Thomas Granger Stewart in describing the loss of recoil in patients with cerebellar hemispheric tumors in 1904. Volunteering in 1914 for frontline hospital duty, he examined soldiers who had injuries to their occipital area causing hypotonia, dysmetria, staggering gait, and falling to the side ipsilateral to their injured cerebellar hemisphere. Holmes discovered that increasing the pace of the finger-nose manuever and applying slight resistance to a moving limb attenuated the dysmetria. Continuing observation of these patients afforded him to describe the evolution of their injuries to include increasing tremor and decreasing hypotonia. Holmes first attached levers to the limbs of hispatients to record their movements on a moving smoked paper kymograph. In 1939 he published photograh tracings made by low mass minature light bulbs attached to ataxic limbs that showed thehpometira and hypometria of their movements ipsilateral to their damaged cerebellar lobes. Holmes made sigficant contributions to understanding of the physiology of the human cerebellum.

by Paolo Mazzarello , 512 pp., Oxford University Press, 2010, $69.95 This biography extensively documents not only of the life of Camillo Golgi, co-winner of the 1906 Noble Prize in Medicine or Physiology, but also superbly summarizes his discovery of the “black reaction” staining dendrites and axons, the reticular system (Golgi apparatus), and life cycles of parasites. Mazzarello exposes Golgi's errors in constructing and then doggedly defending the reticular theory of neuroanatomy, and his struggles to strengthen the University of Pavia Medical School, his alma mater. In chapter 2, Mazzarello recounts Golgi's ancestry, as well as elementary and medical schooling. Chapter 3 expertly epitomizes the evolution …

edited by Javier DeFelipe , 432 pp., Oxford Press, 2010, $75 This exquisitely illustrated book was edited by Javier DeFelipe, an internationally known interpreter of and translator of Santiago Ramon y Cajal's writings and member of the Insituto Cajal in Madrid, Spain. The curious title derives from Cajal's' Recuerdos de Mi Vida , in which he wrote that “. . . my attention was drawn to the flower garden of the gray matter, which contained cells with delicate and elegant forms, the mysterious butterflies of the soul , the beating of whose wings may some day (who knows) clarify the secret of mental life.” The book is divided into Introduction and the Gallery of Drawings. The Introduction contains introductory remarks that describe anatomic features of neurons and glia with their interrelations. A Sketch History of the …