Emilio D. Soria

Disappearance of thalamic pain after parietal subcortical stroke

A hypertensive man had a long standing history of contumacious hyperpathia in the right upper extremity, resistant to medical therapy, secondary to a lacunar infarct in the left thalamus. A second cerebrovascular accident caused a small lesion in the left corona radiata, interrupting the thalamoparietal interconnections, and terminated the pain instantly. Interruption of the subcortical parietal white matter may more effectively control pain than cortical lesions. A few surgeons have successfully treated rebellious chronic pain with stereotaxic operations in the corona radiata, resulting in lesions very similar to our patients. This overlooked and nearly forgotten technique may still have value in treating selected cases.

The history of the blink reflex.

Most of Walker Overend’s seminal observations about the blink reflex remain unrefuted after 9 decades.’ In a succinct letter to the editor of Lancet in 1896, he reported that when the skin of the forehead is gently tapped with a stethoscope, the lower eyelid twitches on the same side, and slight tapping in the middle line of the forehead is followed by twitching in both eyelids. Overend further noted that the response has a motor pathway identical to that of the conjunctival reflex, and in severe cases of hemiplegia, the reflex is absent on the paralyzed side for a few days although the patient may close the eye perfectly. The reflex is not produced by communication of physical vibration. It is a true skin reflex and not a periosteal reaction.‘ This article recounts the life and work of Overend and contenders to the claim of priority for the discovery of the reflex. Their debates over priority and descriptions of the reflex are examined. The validity of Overend’s observations are judged by comparison with contemporary knowledge about the physiology of the reflex in normal and disease states. Walker Overend was born in Keighley, Yorkshire County, England, in 1858. Educated a t Skipton Grammar School, he won t h e Queen’s Scholarship to attend the Royal School of Mines in 1874.2 Four years later, he was awarded a scholarship to obtain a BSci a t the University of London, a n d in 1882 h e garnered t h e Brackenbury Scholarship at Balliol College in Oxford where he graduated with highest honors in physiology in 1886. He spent the following year on a Radcliffe Traveling Fellowship and studied the effects of curare and veratrine on striated muscle a t the Universities of Heidelberg and Strassbourg. After his return from the continent, he lectured in physiology a t St. George’s Hospital for 1 year, and in 1892 he published a textbook for medical students, The Elements of Human Physiology.2.3 Overend graduated with a BChir from Oxford in 1893 and formed a general practice with a classmate in Edmonton.2 In a letter to the editor published in Lancet on March 7, 1896, he described “a new cranial reflex.”’ The entire text is reproduced in figure 1. A pulmonary condition drove him from the smoky suburbs of London to the salubrious seaside town of Clacton-on-Sea. There he installed one of England’s first x-ray apparatuses in 1902. He became so enthralled with radiology that he gave up general practice in 1912 to devote himself entirely to this specialty.2 He developed an extensive consultation practice a t hospitals in the countryside east of London. In later years, he practiced with his son, Thomas.2 Overend’s portrait, almost forgotten, hangs in a corridor leading to the departm e n t h e once headed a t Royal E a s t Sussex Hospital in Hastings, England (figure 2). Overend correlated symptoms with radiographic a n d postmortem f indings i n h is book, T h e Radiology of the Chest.3 He made lasting contributions to a number of fields, including physiology, neurology, and radiology. He died on February 10, 1926, 2 years before the American publication of the second volume of his b o ~ k . ~ , ~ In 1901, Daniel Joseph McCarthy published an account of the supraorbital reflex without acknowledging Overend’s p r i ~ r i t y . ~ McCarthy, a Philadelphian, curiously published his observations in German, the title of which translates to English as “The supraorbital reflex. A new reflex in the territory of the 5th and 7 th cranial nerve pairs.” McCarthy elicited the supraorbital reflex by striking the skin overlying the nerve or the skin of the forehead up to the hairline with a percussion hammer. He also noted the bilateral response tha t Overend observed and that a tap on either side of the midline of the forehead usually elicited contraction of the orbicularis oculi. He substantiated Overend’s observation that facial paralysis eliminated the reflex and found that complete division of the supraorbital nerve for neuralga extinguished the reflex.5 General paresis abolished the reflex, while tabes dorsalis, in most cases, only diminished i t . 5 McCarthy did not examine t h e reflex in patients with hemiplegia or Parkinson’s disease. He concluded that supraorbital reflexes were “pure nerve reflexes” identical to tendon reflexes.5 Daniel McCarthy was born on June 22, 1874, in Philadelphia, Pennsylvania, where he received his

Association of intracranial meningioma with arteriovenous malformation

Simultaneous occurrence of a cerebral arteriovenous malformation and a primary brain tumor is rare. A case of a left occipital meningioma and a right parietotemporal arteriovenous malformation is reported. Clinical, radiological, and postmortem findings are described. Thirty previous reports of arteriovenous malformations associated with primary brain tumors are reviewed. In 18 cases the two lesions were intermixed or in close proximity. This spatial relationship between the lesions suggests more than a coincidental association. Several hypotheses are proposed to explain common causal connections.

The Contributions of Dr. Roswell Park to Epilepsy and Spinal Surgery

ROSWELL PARK, M.D., (1852-1914) is remembered for founding the worlds 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. Parks 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 Ferriers research on localization of cerebral cortical function and Victor Horsleys 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. Parks case reports of successful operations on patients deemed almost incurable reveal boldness and ingenuity. Parks untimely death truncated a promising career.