**History of Stroke**

Editors

**Julien Bogousslavsky Maurizio Paciaroni Michael G. Hennerici Laurent Tatu**

Basel • Beijing • Wuhan • Barcelona • Belgrade • Novi Sad • Cluj • Manchester

*Editors* Julien Bogousslavsky Center for Brain and Nervous System Diseases Swiss Medical Network, Clinique Valmont Glion, Switzerland

Michael G. Hennerici University of Heidelberg Mannheim/Heidelberg, Germany Maurizio Paciaroni Santa Maria della Misericordia Hospital, University of Perugia Perugia (Italy)

Laurent Tatu CHU Besanc¸on - University of Franche-Comte´ Besanc¸on, France

*Editorial Office* MDPI St. Alban-Anlage 66 4052 Basel, Switzerland

For citation purposes, cite each chapter independently as indicated below:

Lastname, Firstname, Firstname Lastname, and Firstname Lastname. Year. Chapter Title. In *Book Title*. Edited by Editor 1 and Editor 2. Series Title (optional). Basel: MDPI, Page Range.

**ISBN 978-3-0365-2314-9 (Hbk) ISBN 978-3-0365-2313-2 (PDF) doi.org/10.3390/books978-3-0365-2313-2**

© 2023 by the authors. Articles in this book are Open Access and distributed under the Creative Commons Attribution (CC BY) license. The book as a whole is distributed by MDPI under the terms and conditions of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) license.

## **Contents**


## **About the Editors**

Julien Bogousslavsky, a former full professor of neurology and head of university department of neurology in Switzerland, now chairs the Center for brain and nervous system disorders of the Swiss Medical Network, along with his position of Chief editor of European Neurology, the third oldest neurological journal. He was founder of the European Stroke Conference and of the journal Cerebrovascular Diseases along with Michael Hennerici, and was the millenium president of the International Stroke Society. He has published over 700 scientific papers and books, and is also the author of works and brain and creativity, writers such as Marcel Proust or Blaise Cendrars, Surrealism, and the relationships between avant-garde poets and artists.

Maurizio Paciaroni, having completed his 4-year university specialization course in Neurology, at the University of Perugia in Italy, went on to became a Research Fellow in the field of vascular neurology at the University of Lausanne in Switzerland. Subsequently, he participated in NASCET (North American Symptomatic Carotid Endarterectomy Trial) at the Robarts Research Institute, the University of Western Ontario, London Ontario, Canada. Currently, he is the team leader of the Stroke Unit at the University of Perugia Hospital, Italy. He has published more than 250 research papers, in both English and Italian, and has co-authored several chapters and texts on stroke.

Michael G. Hennerici is professor emeritus and former chairman of the department of neurology as well as medical director of the Mannheim Hospital at the University of Heidelberg, Germany. Along with Julien Bogousslavsky (Switzerland) he was founder and chairman of the European Stroke Conference (ESC) in 1990 (Dusseldorf, Germany) and the journal Cerebrovascular Diseases ¨ (Honorary Editor and Founding Editor in Chief) for more than a quarter of a century. He has published more than 850 scientific papers and books on all aspects of research in basic neurophysiology as well as imaging principles of the brain and its vasculature (Ultrasound, CT and MRI), all aspects of Cerebrovascular Diseases (eg. diagnosis, management and treatment in exploratory pilot and large clinical trials) and pioneer studies of the Natural History of Asymptomatic Carotid Disease in particular (1987). Along with his wife Marion Hennerici, who early joined the ESC Executive Committee, he founded the European Stroke Research Foundation (ESRF), which today continuously supports numerous applications of researchers worldwide (https://www.esrf.website). Following his primary education in musical arts (Organist diploma) and numerous concerts given, he later became interested in brain diseases of musicians and painting artists as well as their relationships to stroke.This also follows the spirits of education at the Department of Neurology and Neurophysiology in Freiburg im Breisgau, Germany during his student's education in the early 1970s.

Laurent Tatu is professor of anatomy and neurologist. He is the coordinator of the Department of Anatomy at the University of Franche-Comte (France) and ´ head of the Neuromuscular Diseases Department at Besanc¸on University Hospital. His main research topics are vascular anatomy of the brain and morphological and functional muscle anatomy applied to botulinum toxin therapy for neurological diseases. He is an associate editor of the journals "European Neurology" and "Case Reports in Neurology". With a longstanding interest in history, he is the author of works on the history of medicine and the history of the First World War. With Julien Bogousslavsky, he has published numerous articles on the history of medicine and three books on neuropsychiatry in the First World War (2012), Blaise Cendrars (2015) and Gustave Roussy (2023).

## **Preface**

It is fashionable today to say that one wants to live in the present moment. But beyond this simple cliche, one forgets what "the present" corresponds to. Indeed, to ´ be somewhat provocative, the present is never really present, since it immediately disappears to be replaced by another momentum, which also disappears, and so on. The future also does not exist. So, what does exist or is at least more stable when one considers the passage of time? The past. In fact, the past, i.e., "history", is what precisely defines what we are today, how we experience the transience of the "here and now", and how we may plan what is coming next. For this reason, like in all human sciences, history is of utmost importance to understand events, developments, successes, and failures in medicine. In addition, at the neurophysiological level, this corresponds well to the general functioning of the brain, which is based on acquired patterns, i.e., "memory" in the broadest sense. Thus, one could say that the appropriate integration of the past is the sine qua non condition for a normal present life and future planning.

Given the importance of the brain and nervous system in general in human activities, the history of neurology and neuroscience is a truly privileged and particularly fascinating field in the history of medicine. In this domain, however, very little has been written on the historical evolution of cerebrovascular disease and stroke. This may be due to the fact that stroke has often been classified in the border zone—sometimes a no man's land—between internal medicine, angiology, and neurology. For instance, when I started my training, practicing and academic neurologists seemed much more interested in diseases of the nerves and muscles than stroke. In many countries, brain lesion management was left to neurosurgeons. And I remember the smiles and laughs of more senior colleagues when my chief appointed me as a consultant to the "division of hemiplegia", which at the time belonged to internal medicine in the hospital. As is often the case, however, the punishment could be transformed into a positive experience. Indeed, beyond the therapeutic issues, which at the time were rather limited, I discovered that strokes were probably the easiest, most common, and most interesting way to understand how focal brain lesions may affect neurological function, including changes in complex phenomena, such as behavior. Along with therapeutic progress, stroke subsequently acquired better interest from clinicians in general, and it has now become a very significant field of academic and clinical neurology.

While its particular historical development may have inhibited extensive research on its evolution over the centuries, it is also the reason why this topic is of particular interest today, with large parts still waiting to be studied. To my knowledge, the first attempt to publish a book on the history of stroke was by William Fields and Noreen Lemak in 1989. However, it placed a strong emphasis on ancient texts, which made it not so easy to read by non-scholars, given the dramatic changes in medicine from antiquity to modern times. This is why we have decided to focus the present book on more recent history, mainly from the nineteenth century up to the most recent advances in stroke diagnosis and management, when this picture can give a striking impression of the fascinating chronological developments in the stroke field over the last two hundred years. This is also the process we followed after we launched the European Stroke Conference in 1990 with Michael Hennerici in introducing historical overviews in the scientific program as often as possible.

In the following chapters, the concepts of apoplexy and brain softening, atheroma–thrombosis–embolism, and small versus large artery disease have been traced over the decades, with a focus on investigations, diagnosis, and treatment, including prevention, acute therapy, and rehabilitation. Because of their specific interest associated with historical issues, some other topics have also been covered, such as vascular cognitive impairment or the influence of stroke on art.

Along with my co-editors, I am deeply grateful to the authors of the following chapters who have provided thorough, innovative, and stimulating overviews of these topics from a historical perspective. One of the goals of this book is to trigger interest in the history of neurology in general through the periscope of the history of cerebrovascular disease and stroke. Indeed, probably even more than in other domains, the field of stroke history has been only partially explored, and many fascinating topics in this field remain to be studied.

## *Julien Bogousslavsky* **for the Editors** *Maurizio Paciaroni***,** *Michael G. Hennerici* **and** *Laurent Tatu Editors*

## **Contributors**

## **Bartlomiej Piechowski-Jozwiak**

Staff Physician Neurological Institute, Cleveland Clinic Abu Dhabi, The United Arab Emirates; Honorary Consultant Neurologist King's College Hospital, Denmark Hill, London, UK

## **Carmen Calvello**

Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

**Frederic Assal** Medecin H ´ opitaux Universitaires ˆ de Geneve et Facult ` e de m ´ edecine ´

## **Giacomo Baso**

"Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan

## **Giorgio Silvestrelli**

Stroke Unit, Department of Neuroscience ASST Mantova, Italy

## **Giacomo Staffolani**

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy

## **Jukka Putaala**

Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

**Julien Bogousslavsky** Clinique Valmont Route de Valmont 1823 Glion sur Montreux

## **Kateryna Antonenko**

Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, 3010, Switzerland

## **Laurent Tatu**

Department of Neuromuscular diseases and Department of Anatomy. CHU Besanc¸on - University of Franche-Comte´ Besanc¸on, France

## **Leonardo Pantoni**

"Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan

## **Lucia Gentili**

Department of Neurology and Stroke Unit, USL Umbria1, Citta di ` Castello, Italy

## **Lukas Sveikata**

Chef de Clinique scientifique Hopitaux Universitaires de Gen ˆ eve ` et Faculte de m ´ edecine ´

## **Maria Giulia Mosconi**

Clinical Researcher Santa Maria Della Misericordia Hospital-University of Perugia, Cardiovascular Medicine-Stroke Unit, Perugia, Italy

## **Maurizio Paciaroni**

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy

## **Mauro Zampolini**

Neurologia-Stroke Unit, Dipartimento di Neuroriabilitazione, Ospedale S. Giovanni Battista, USLUmbria 2

**Michael G. Hennerici** University of Heidelberg, Heidelberg, Germany

## **Michela Giustozzi**

Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy

## **Monica Acciarresi**

Neurologia-Stroke Unit, Dipartimento di Neuroriabilitazione, Ospedale S. Giovanni Battista, USLUmbria 2

**Norbert Nighoghossian** University Claude Bernard Lyon

**Olivier Walusinski** Family Physician, Private practice Laureat de l'Acad ´ emie ´ de Medecine (Paris) ´

## **Roberta Rinaldi**

Department of Neurology and Stroke Unit, San Giovanni Battista Hospital, Foligno, 06034, Italy

## **Stephen Meairs**

University of Heidelberg, Heidelberg, Germany
