The Charcot-Bouchard controversy

Jean-Martin Charcot: the polymath

Jean-Martin Charcot, widely regarded as a leading founder of modern neurology, made substantial contributions to the understanding and characterization of numerous medical conditions. His initial focus was on internal medicine, later expanding to include neuropathology, general neurology, and eventually emerging fields such as neuropsychology and neuropsychiatry. Furthermore, Charcot's intellectual pursuits extended beyond medicine, encompassing research in art history, medical iconography, sociology, religious studies, and the arts, solidifying his status as a polymath.

Charles Jacques Bouchard (1837-1915) and the Charcot-Bouchard aneurysm

Charles Jacques Bouchard was a distinguished French physician and scientist of the early 19th century. Despite his humble beginnings, Bouchard was able to achieve meteoric success within the scientific and medical fields, establishing himself as one of the most influential physician-scientists of his time. This was in part due to his superb commitment, as well as the prosperity engendered by the strong influence of his teachers, which can be seen as a testament to the importance of mentorship in medicine. Besides his myriad contributions, Bouchard is most well known for describing the Charcot-Bouchard aneurysm in 1866 alongside his mentor Jean-Martin Charcot, linking them for the first time to intracranial hemorrhage. Bouchard's thesis entitled "A Study of Some Points in the Pathology of Cerebral Hemorrhage" was regarded by some as the most original and important of all recent works on the subject of cerebral hemorrhage at the time of publication. Sadly, the great relationship Bouchard shared with his mentor Charcot would later deteriorate into perhaps one of the most well-known student-mentor quarrels in the history of medicine. Herein, the authors present a historical recollection of Bouchard's life, career, and contributions to medicine, as well as the famous controversy with Jean-Martin Charcot.

Coronavirus disease 2019 (COVID-19) can predispose young to Intracerebral hemorrhage: a retrospective observational study

Background

The respiratory system involvement is the most common presentation of Coronavirus disease 2019 (COVID-19). However, other organs including the central nervous system (CNS) could be affected by the virus. Strokes, seizures, change in mental status, and encephalitis have been reported as the neurological manifestation of the disease. We hypothesized that COVID-19 could predispose younger patients to spontaneous intracerebral hemorrhage (ICH). The present study aimed to investigate whether COVID-19 has any relationship with the occurrence of spontaneous ICH in young or not.

Methods

We retrospectively evaluated all the patients with spontaneous ICH who were referred to our center between 20 Feb and 1 Sep 2020. The demographic, clinical, radiological, and laboratory test data were evaluated. Patients were divided into two groups. The COVID-19 positive patients and COVID-19 negative ones. All the variables including age, sex, history of hypertension, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume and location, the presence of intraventricular hemorrhage and hydrocephalus on admission, the length of hospital stay, the lab test results and the clinical outcome at last visit or discharge as Glasgow Outcome Scale (GOS) were compared between the two groups.

Results

There were 22 COVID-19 positive patients (20.8%) and 84 COVID-19 negative ones (79.2%). The mean age of the patients in the case group (54.27 ± 4.67) was significantly lower than that in the control group (69.88 ± 4.47) (p < 0.05). Meanwhile, our results showed a significant difference between the two groups based on the presence of chronic arterial hypertension (p < 0.05). There were no significant differences between the two groups based on gender, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume, need for surgery, the presence of intraventricular hemorrhage and hydrocephalus on admission, White Blood Cell (WBC) count, platelet count, Prothrombin Time (PT), and Partial Thromboplastin Time (PTT) (p > 0.05).

Conclusions

Our results show that COVID positive patients with ICH are younger and with less predisposing factors than COVID negative subjects with ICH.

Jean-martin charcot pathologist, neurologist, psychiatrist and physician

Jean-Martin Charcot is known as father of modern neurology. Before him, neurology was only limited to select disorders like chorea. His contributions were not limited to neurology only, as he was instrumental in many new developments in the field of pathology, psychiatry, and internal medicine. Even after 100 years, Charcot`s clinical methods remain the pillar of modern neurology.

Neurology and surrealism: André Breton and Joseph Babinski

Before he became the initiator of the surrealist movement, André Breton (1896-1966) studied medicine and worked as a student in several hospitals and as a stretcher bearer at the front during World War I. There he became interested in psychiatric diseases such as hysteria and psychosis, which later served as a source of inspiration for his surrealist writings and thoughts, in particular on automatic writing. Breton worked under Joseph Babinski at La Pitié, nearby La Salpêtrière, and became impressed by the 'sacred fever' of the famous neurologist. In this article, we describe the relationship between Breton and Babinski and try to trace back whether not only Breton's psychiatric, but also his neurological experiences, have influenced surrealism. We hypothesize that Breton left medicine in 1920 partly as a consequence of his stay with Babinski.

Charcot et Babinski: au-delà de la simple relation professeur-élève

Charcot and Babinski: beyond a simple teacher-student relationship. Jean-Martin Charcot (18251893) is now considered to be the father of clinical neurology in France. He trained a generation of eminent neurologists, among them Joseph Babinski, with whom he had a special relationship. Babinski was undoubtedly Charcot's favorite pupil and they enjoyed an excellent collaboration at la Salpétrière. Even though both men felt tremendous respect for each other, it is sad that this relationship may, in one instance, have been detrimental to Babinski. This is probably the reason why Bouchard denied him full professorship, a decision with eventual consequences for both men. In spite of this, the neurologist of Polish origin held his master in tremendous admiration, even as he pursued Charcot's research on hysteria after his death. Even though Babinski eventually contradicted his master on many fundamental issues, it did not affect his devotion to him. The relationship between the two men can be considered as more than a simple relationship between a teacher and his pupil and may be compared to a father-son relationship, which is a reminder of the original model of Hippocratic teaching.

The Babinski sign

Babinski's life and the story of the Babinski sign are summarised. The physiological basis of the sign is discussed.

The Babinski sign: the first hundred years

The year 1996 marks the centenary of Babinski's description of the toe responses (normal and pathological) after stimulation of the sole of the foot. The upgoing toe response is normal in the 1st year of life and forms part of the flexion synergy of the leg, which had been known before 1896. Babinski also recognized the relation between the toe phenomenon (phénomène des orteils) in older children and adults and dysfunction of the pyramidal system. Neurologists became so fascinated by toe responses alone that many competing signs were proposed; most of these consisted of stimuli at other parts of the leg and were actually part of the same-but temporarily forgotten-flexion synergy. From 1910 to 1915 Marie and Foix and also Walshe re-emphasized this relationship and pointed out the analogy with the flexion reflex of the dog that had been extensively studied by Sherrington; the toe "extensors" shorten the leg and therefore they are flexors in a physiological sense. The normal (downward) toe response of the toes does not belong to a more complex movement, although Babinski originally believed this; it is a monosegmental skin reflex, akin to abdominal reflexes. Babinski correctly predicted that dysfunction of the pyramidal tract is not synonymous with a lesion, and that this dysfunction of the pyramidal system is necessary but not sufficient to produce a phénomène des orteils.

On the names of Babiński

The 100th anniversary of the discovery of the extensor plantar response will be celebrated in 1996. It was Joseph François Félix Babiński who became known worldwide for the sign that bears his name. In order to help Joseph in establishing his career, brother Henri gave up his aspirations and abandoned engineering. Clovis Vincent, "father' of French neurosurgery and pupil of Joseph, stated: "Joseph Babinski lived for science, and Henri lived for his brother; without Henri Babinski, Joseph would not have accomplished that much". However, Henri's name became famous in all Paris for a cookbook Gastronomie Pratique written under the pseudonym of "Ali-Bab.' Throughout Joseph's career his surname remained distorted despite his own efforts to spell and pronounce it correctly. Several people can claim the name Babiński, but in neurology and neurosurgery there is only one, Joseph.