"C3, C4, C5 keep you alive," or do they?
Contrary to traditional teaching in anatomy courses, historical data suggest that bilateral loss of phrenic nerve function does not necessarily result in death.
Adult↗
Biomedical subjects
Joel A Vilensky
Publications and source records attributed to Joel A Vilensky.
Movement disorders associated with encephalitis lethargica: a video compilation.
Encephalitis lethargica (EL; epidemic encephalitis; von Economo's disease) often presented with a movement disorder, and the motor consequences of postencephalitic parkinsonism (PEP) were characteristic of the chronic sequelae of this condition. PEP was similar to Parkinson's disease but was more variable and had some distinct features such as oculogyric crises. Although two previous publications have included video images of the movement disorders associated with EL and PEP, the sequences presented were typically short, showed only a few patients, and did not include the work of several neurologists who had the foresight to preserve filmed images of their patients. We describe the most complete record of EL and PEP moving images that have been preserved and make them available in edited form.
Disease Outbreaks↗
Early cinematographic studies of generalized dystonia.
Among movement disorders, dystonia is a particularly complex phenomenon and difficult to describe. For this reason, cinematographic documents were particularly important to the establishment of this disorder within the neurological nosology. The seminal 1944 article on dystonia by E. Herz anchored its arguments in moving film documentation, published with frame-by-frame demonstrations of dystonic patients. Although the original films that comprised the basis of this article have not been located, two related contemporaneous films, one by Herz in association with T.J. Putnam, and one by S.P. Goodhart and B.H. Balser, have been located. Incorporating standard and several innovative filming techniques, these films and their accompanying text material capture the particular movements of dystonia, revealing the anatomical patterns of the twisting spasms, and emphasize their action exacerbation. The films demonstrate the variety of dystonic movements appreciated during this period, consider psychogenic, postencephalitic, and hereditary forms, and refer to the treatment of dystonia by surgery and plaster casts.
Dystonia↗
Experimental confirmation by Sir Victor Horsley of the relationship between thyroid gland dysfunction and myxedema.
Whereas Sir Victor Horsley is well known for his many contributions to neurosurgery, this is not the case for his treatments for both myxedema and cretinism. Horsley's research on thyroid physiology was concentrated in the years 1884-1890, while he was director of the Brown Institute for Animals. Based upon experimentation with dogs and monkeys as well as some human patients, Horsley demonstrated conclusively that removal of the thyroid gland produced tremors, rigidity, and paralysis, which he attributed to changes in lower motor centers. Furthermore, the development of imbecility suggested that thyroid excision produced deficits in higher cortical functioning. Horsley showed that it was possible to alleviate temporarily some of the psychological and physiological symptoms of both myxedema and cretinism using transplanted thyroid tissue. Several of Horsley's students, most notably George Murray, continued and extended his work by examining other ways in which myxedema and cretinism could be treated (e.g., by injecting an extract of thyroid tissue).
Animals↗
The sacroiliac joint: anatomy, physiology and clinical significance.
The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.
Biomechanical Phenomena↗
Sir Victor Horsley, Mr John Marshall, the nervi nervorum, and pain: more than a century ahead of their time.
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History, 19th Century↗
Victor Horsley and the "neglected malady".
IN 1910, RENOWNED neurosurgeon Sir Victor Horsley published a description of the signs and symptoms associated with a condition he referred to as a "neglected malady." We invite readers to identify the condition, on the basis of Horsley's description.
Brain Neoplasms↗
The publications of Sir Victor Horsley: a listing and an assessment.
Sir Victor Horsley is well recognized as the father of neurological surgery, publishing many articles within this discipline and on other neurologically related topics. Furthermore, he published many important articles in other areas of science and medicine, as well as on social issues (e.g., women's suffrage). Accordingly, we compiled, for the first time, a complete listing of his writings. We briefly describe here some of the characteristics of his bibliography, which is available on the Journal's web site.
History, 19th Century↗
Sir Felix Semon and Semon's law.
Explore the source record for details and available documents.
History, 20th Century↗
"On the physiology of micturition" by Denny-Brown and Robertson: a classic paper revisited.
Explore the source record for details and available documents.
Autonomic Pathways↗
Denny-Brown, Boston City Hospital, and the history of American neurology.
Harvard University's Neurological Unit at Boston City Hospital (BCH) became the premier center for neurological training in the United States during the middle part of the 20th century. During part of this period (1939-1967), it was directed by Derek Denny-Brown, who had been recruited from England by Harvard president James Conant. The training program that Denny-Brown initiated at BCH emphasized neurology as a medical specialty, independent of psychiatry and neurosurgery. This program, which reflected Denny-Brown's British training, was remarkably effective and served as a model for rest of the country.
Biomedical Research↗
Using extirpations to understand the human motor cortex: Horsley, Foerster, and Bucy.
During the last part of the 19th century and through the middle of the 20th century, surgeons sometimes extirpated parts of the human motor cortex to control abnormal involuntary movements. This procedure can be traced directly to Victor Horsley, who pioneered the first successful surgery of this type in 1886. Although many neurosurgeons followed Horsley's lead in performing this procedure, few used their results, as he did, to formulate concepts on the role of the motor cortex in movement control. Otfrid Foerster and Paul Bucy were the principal exceptions. We reviewed the surgical procedures these 3 notable neurosurgeons performed on the motor cortex and the hypotheses they subsequently developed on the functions of the motor cortex. We also evaluated these writings relative to contemporary views of motor cortex function.
England↗
British anti-Lewisite (dimercaprol): an amazing history.
Emergency physicians are familiar with British anti-Lewisite (BAL) because it is a heavy metal-chelating agent that is recommended in some cases of metal poisoning, especially arsenic. Although there are more modern chelating agents, the fact that BAL is still recommended and stocked by hospital pharmacies more than 60 years after its initial synthesis is itself remarkable. During World War II, BAL minimized the risk to the Allied infantry of injury or death from Lewisite, a very potent arsenic-based chemical warfare agent. Once developed, BAL revolutionized the treatment of heavy metal poisonings, both accidental and iatrogenic (eg, toxicity from treatment of arthritis with gold salts). In 1951, BAL was used to treat Wilson's disease with striking success. Today, BAL might again become prominent should terrorists or governments use Lewisite against civilians or military forces.
Arsenicals↗
Feud and fable: the Sherrington-Horsley polemic and the delayed publication.
In the February and March 1894 pages of The Lancet and in private letters, Charles Sherrington and Victor Horsley exchanged angry accusations pertaining to primacy of research on the course of the pyramidal fiber tract as determined from studies in monkeys. The polemics appear not to have ended in a manner satisfactory to either one. Moreover, the dispute allegedly led to a remarkable delay in publication of one of Sherrington's major contributions, which pertained to the localization of the motor cortex in apes that was published in 1917. Here we examine the argument in detail including the comments of an intermediary, Professor Rubert Boyce. We also examine the evidence for the supposed delay in publication, and conclude that the account of the delay originated in John Fulton's 1952 obituary of Sherrington, and is not true. We suggest it has become a fable that should no longer be repeated.
Animals↗
Peripheral and central nervous system mechanisms of joint protection.
Although there are many risk factors (such as age, family history, and obesity) associated with the development of osteoarthritis (OA), only trauma is known to cause OA. The neuromuscular system controls the amount and kind of movement occurring at a joint, so it is this system that is uitimately responsible for ensuring that joint tissues are not damaged to the point of developing OA during normal day-to-day activities. In the present paper, we review and critically evaluate some of the current concepts of the role of peripheral and central nervous system mechanisms that might protect joints from excessive excursion and joint tissues from excessive loading and OA. We conclude that a neuromuscular protective model based on central pattern generators (CPGs--subconscious motor programs) can best reconcile much heretofore ambiguous information pertaining to the development and progression of OA in stable and unstable joints.
Animals↗
Can the sacroiliac joint cause sciatica?
In this brief study we provide evidence that earlier and more recent findings pertaining to the anatomy and physiology of the sacroiliac joint suggest that dysfunction in this joint could, similar to a herniated lumbar disc, produce pain along the sciatic nerve. These observations might explain some of the cases of sciatica in which no disc pathology can be found.
Journal Article↗
Denny-Brown, Wilson's disease, and BAL (British antilewisite [2,3-dimercaptopropanol]).
In 1951 Denny-Brown and Porter described the successful treatment of Wilson's disease using the chelating agent British antilewisite. The presentation of their results both at meetings and in print changed the traditional view of neurology from a descriptive to an interventional discipline using treatments based on the underlying biochemical disorder. The authors review the importance of these reports and provide edited digital versions of the films Denny-Brown made of the five patients described in the initial reports.
Dimercaprol↗
Histologic analysis of neural elements in the human sacroiliac joint.
STUDY DESIGN: The posterior ligament of the human sacroiliac joint was examined for nerves and nerve endings using histologic and immunohistochemical techniques. OBJECTIVE: To identify nerve fibers and mechanoreceptors in the posterior ligament. SUMMARY OF BACKGROUND DATA: According to the findings of previous studies, the human sacroiliac joint receives myelinated and unmyelinated axons that presumably conduct pain and proprioceptive impulses derived from mechanoreceptors and free nerve endings in the human sacroiliac joint. METHODS: Tissue obtained from six patients was stained with gold chloride and that obtained from six additional patients was stained using antibodies specific for substance P and protein gene product 9.5. RESULTS: The staining of joint tissue using the gold chloride technique showed myelinated and unmyelinated nerve fibers, two morphotypes of paciniform encapsulated mechanoreceptors, and a single nonpaciniform mechanoreceptor. Analysis using immunohistochemical staining for protein gene product 9.5 did not unequivocally show axons, nerve fascicles, or mechanoreceptors. Similarly, analysis based on immunohistochemical staining for substance P, one of several neurotransmitters known to signal pain from the periphery, showed reactive elements that may have been nerves, but because of background staining, could not be positively identified as such. CONCLUSIONS: The presence of nerve fibers and mechanoreceptors in the sacroiliac ligament demonstrates that the central nervous system receives information, certainly proprioceptive, and possibly pain from the sacroiliac joint. Although it is not known how the central nervous system uses such information, it seems reasonable to speculate that the proprioceptive information is used to optimize upper body balance at this joint. In addition, because the staining techniques used generally to show nerves and nerve elements in periarticular connective tissue are nonspecific, the distinction between neural and nonneural should be made on the basis of both morphologic and staining characteristics.
Adult↗