A historical review of investigations on laterality of emotions in the human brain

Different models of emotional lateralization, advanced since the first clinical observations raised this issue, will be reviewed following their historical progression. The clinical investigations that have suggested a general dominance of the right hemisphere for all kinds of emotions and the experimental studies that have proposed a different hemispheric specialization for positive vs. negative emotions (valence hypothesis) or for approach vs. withdrawal tendencies (motivational hypothesis) will be reviewed first and extensively. This historical review will be followed by a short discussion of recent anatomo-clinical and activation studies that have investigated (a) emotional and behavioral disorders of patients with asymmetrical forms of fronto-temporal degeneration and (b) laterality effects in specific brain structures (amygdala, ventro-medial prefrontal cortex, and anterior insula) playing a critical role in different components of emotions. Overall, these studies support the hypothesis of a right hemisphere dominance for all components of the emotional system.

Traumatic glioblastoma: commentary and suggested mechanism

The role of head trauma in the development of glioblastoma is highly controversial and has been minimized since first put forward. This is not unexpected because skull injuries are overwhelmingly more common than glioblastoma. This paper presents a commentary based on the contributions of James Ewing, who established a major set of criteria for the recognition of an official relationship between trauma and cancer. Ewing's criteria were very stringent. The scholars who succeeded Ewing have facilitated the characterization of traumatic brain injuries since the introduction of computed tomography and magnetic resonance imaging. Discussions of the various criteria that have since developed are now being conducted, and those of an unnecessarily limiting nature are being highlighted. Three transcription factors associated with traumatic brain injury have been identified: p53, hypoxia-inducible factor-1α, and c-MYC. A role for these three transcription factors in the relationship between traumatic brain injury and glioblastoma is suggested; this role may support a cause-and-effect link with the subsequent development of glioblastoma.

Arthur Simons (1877-1942) and Tonic Neck Reflexes With Hemiplegic "Mitbewegungen" (Associated Reactions): Cinematography From 1916-1919

Tonic neck reflexes were investigated by Rudolf Magnus and Adriaan de Kleijn in animals and men in 1912 and eventually by Arthur Simons, a neurologist in Berlin and coworker of Hermann Oppenheim. Simons studied these reflexes in hemiplegic patients, who were mainly victims of World War I. This work became his most important contribution and remained unsurpassed for many years. The film (Filmarchiv, Bundesarchiv [Film Archive, National Archive] Berlin) with Simons as an examiner shows 11 war casualties with brain lesions that occurred between 1916 and 1919. The injuries reveal asymmetric neck reflexes with "Mitbewegungen," that is, flexion or extension on the hemiplegic side. Mitbewegungen is identical with Francis Walshe's "associated reactions" caused by neck rotation and/or by cocontraction of the nonaffected extremities, for example, by closing of the fist (Walshe). The knowledge of the neck reflexes is important in acute neurology and in rehabilitation therapy of hemiplegics for antispastic positions. Simons' investigations were conducted in the early era of increasing use of cinematography in medical studies. The film had been nearly forgotten until its rediscovery in 2010.

A century of British military neurosurgery

At the time of the Boer War in 1899 penetrating head injuries, which formed a large proportion of the battlefield casualties, resulted in almost 100% mortality. Since that time up to the present day, significant improvements in technique, equipment and organisation have reduced the mortality to about 10%.

A Physiologist's War: Captain T. Graham Brown RAMC (1915-1919)

During the five years before the outbreak of the First World War, Thomas Graham Brown (1882-1965) conducted research into the control of locomotion that gained him a deserved and long-lasting reputation as a neuroscientist and, in 1927, was recognized by election to the Fellowship of the Royal Society. In 1915, with the First World War raging, he agonized about continuing his research or joining the Royal Army Medical Corps (RAMC). Told by his father to seek a commission, he served two and half years in Macedonia with the British Salonika Force. Whilst in Greece, he kept a daily diary. The entries from June 1916 to May 1917 are extant. They are unpublished and provide the background to the narrative to follow. Casualties with traumatic injury to the brain and spinal cord afforded him the opportunity to carry out careful observations, particularly concerning sensory localization, which resulted in novel findings and his observations on shell shock led to him being called as an expert witness to the national inquiry into the nature and treatment of the condition. In 1920, Graham Brown was appointed to the Chair of Physiology in Cardiff, which he held until 1947.

Battle for the mind: World War 1 and the birth of military psychiatry

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the efficacy of forward psychiatry were inflated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance-not as an opportunity for self-congratulation.

A history of depressed skull fractures from ancient times to 1800

The story of managing depressed fractures illustrates how knowledge of proven value does not always get handed down. Celsus was the first to describe sensible management for depressed fractures. As he wrote in Latin this was forgotten. Galen's Greek writings survived forming the basis of management until the sixteenth century. In 1517, Hans von Gersdorff published a formidable illustrated surgical text. One illustration depicts an instrument for elevating depressed bone fragments. It looked dramatic but could not work and its defects were finally defined in the eighteenth century. Ambroise Paré used a bone punch just as we do today, but no later surgeon mentions this, though the instrument was well known. Elements of chance, fashion, emotionally powerful illustrations, and perhaps stubbornness had a profound effect on management delaying rational treatment for centuries.

["A shot at the father: a student's assault". Sigmund Freud and the case of Ernst Haberl]

In the fall of 1922, the Freud family was involved in a criminal case: The son of Mathilde Freud's nursing sister, Ernst Haberl, had shot at his father. With the help of August Aichhorn the Viennese Juvenile Court's social assistance department was engaged on behalf of the young man. Freud commissioned the lawyer Valentin Teirich to defend him in court. The Viennese dailies reported the deed and the trial extensively (Haberl was acquitted). That a comment published in the Neue Freie Presse was written by Freud himself, as Teirich believed, is, according to Anna Freud, highly improbable.

Cases of aphasia in a work on medicine from the 16th century

The purpose of this paper is to bring to the attention of the international community the role in the history of aphasiology of the eminent Renaissance figure, the Extremaduran Francisco Arceo de Fregenal. To present the subject, after a brief biography of this surgeon, we will trace the development of the concept of aphasia up to the 16th century. In some ancient cultures we find that this disorder was described as a "cerebral accident", to be presented subsequently in the Middle Ages as a divine punishment, only for the original idea to be taken up again during the Renaissance. This return to the concept of the early civilisations was not to lead to the formal classification of this condition however, until the studies of Broca and Wernicke were published in the 19th century. The contribution of Arceo lies in the description of clinical cases included in his book De Recta cvrandorum, which are presented in their original written version in Latin accompanied by a translation in English. The first of these cases tells of spontaneous recovery from the disease, and the second of the evolution of a patient with aphasia secondary to traumatic brain injury following surgery. Despite the great value of Arceo's report, the historical context and his professional attitude did not allow for a localisationist interpretation of the concept of aphasia.

[Neuropsychological rehabilitation in wartime]

INTRODUCTION

The decrease in the rate of mortality due to brain damage during the First World War resulted in a large number of veterans with neurological or neuropsychological sequelae. This situation, which was unknown up until then, called for the development of new therapeutic approaches to help them reach acceptable levels of autonomy.

DEVELOPMENT

This article reviews the relationship between neuropsychological rehabilitation and warfare, and describes the contributions made by different professionals in this field in the two great conflicts of the 20th century. The First World War was to mark the beginning of neuropsychological rehabilitation as we know it today. Some of the most outstanding contributions in that period were those made by Goldstein and Popplereuter in Germany or Franz in the United States. The Second World War was to consolidate this healthcare discipline, the leading figures at that time being Zangwill in England and Luria in the Soviet Union. Despite being of less importance, geopolitically speaking, the study also includes the Yom Kippur War, which exemplifies how warfare can stimulate the development of neuropsychological intervention programmes.

CONCLUSIONS

Today's neuropsychological rehabilitation programmes are closely linked to the interventions used in wartime by Goldstein, Zangwill or Luria. The means employed may have changed, but the aims are still the same, i.e. to help people with brain damage manage to adapt to their new lives.

Mapping connectivity damage in the case of Phineas Gage

White matter (WM) mapping of the human brain using neuroimaging techniques has gained considerable interest in the neuroscience community. Using diffusion weighted (DWI) and magnetic resonance imaging (MRI), WM fiber pathways between brain regions may be systematically assessed to make inferences concerning their role in normal brain function, influence on behavior, as well as concerning the consequences of network-level brain damage. In this paper, we investigate the detailed connectomics in a noted example of severe traumatic brain injury (TBI) which has proved important to and controversial in the history of neuroscience. We model the WM damage in the notable case of Phineas P. Gage, in whom a "tamping iron" was accidentally shot through his skull and brain, resulting in profound behavioral changes. The specific effects of this injury on Mr. Gage's WM connectivity have not previously been considered in detail. Using computed tomography (CT) image data of the Gage skull in conjunction with modern anatomical MRI and diffusion imaging data obtained in contemporary right handed male subjects (aged 25-36), we computationally simulate the passage of the iron through the skull on the basis of reported and observed skull fiducial landmarks and assess the extent of cortical gray matter (GM) and WM damage. Specifically, we find that while considerable damage was, indeed, localized to the left frontal cortex, the impact on measures of network connectedness between directly affected and other brain areas was profound, widespread, and a probable contributor to both the reported acute as well as long-term behavioral changes. Yet, while significantly affecting several likely network hubs, damage to Mr. Gage's WM network may not have been more severe than expected from that of a similarly sized "average" brain lesion. These results provide new insight into the remarkable brain injury experienced by this noteworthy patient.

Brains in context in the neurolaw debate: the examples of free will and "dangerous" brains

Will neuroscience revolutionize forensic practice and our legal institutions? In the debate about the legal implications of brain research, free will and the neural bases of antisocial or criminal behavior are of central importance. By analyzing frequently quoted examples for the unconscious determinants of behavior and antisocial personality changes caused by brain lesions in a wider psychological and social context, the paper argues for a cautious middle position: Evidence for an impending normative "neuro-revolution" is scarce and neuroscience may instead gradually improve legal practice in the long run, particularly where normative questions directly pertain to brain-related questions. In the conclusion the paper raises concerns that applying neuroscience methods about an individual's responsibility or dangerousness is premature at the present time and carries serious individual and societal risks. Putting findings from brain research in wider contexts renders them empirically investigable in a way that does not neglect psychological and social aspects of human mind and behavior.

[Phineas Gage and the enigma of the prefrontal cortex]

Perhaps the most famous brain injury in history was a penetrating wound suffered by a rail road worker named Phineas Gage on September 13, 1848. Twelve years after his injury, on the 21st of May, 1860 Phineas Gage died of an epileptic seizure. In 1868 Dr. Harlow gave an outline of Gage's case history and first disclosed his remarkable personality change. One might think this report would assure Gage a permanent place in the annals of neurology, but this was not the case. There was a good reason for this neglect: hardly anyone knew about Harlow's 1868 report. Dr. David Ferrier, an early proponent of the localisation of cerebral function, rescued Gage from obscurity and used the case as the highlight of his famous 1878 Goulstonian lectures. Gage had, through a tragic natural experiment, provided proof of what Ferrier's studies showed: the pre-frontal cortex was not a "non-functional" brain area. A rod going through the prefrontal cortex of Phineas Gage signalled the beginning of the quest to understand the enigmas of this fascinating region of the brain.

Margaret Kennard (1899-1975): not a 'principle' of brain plasticity but a founding mother of developmental neuropsychology

According to the 'Kennard Principle', there is a negative linear relation between age at brain injury and functional outcome. Other things being equal, the younger the lesioned organism, the better the outcome. But the 'Kennard Principle' is neither Kennard's nor a principle. In her work, Kennard sought to explain the factors that predicted functional outcome (age, to be sure, but also staging, laterality, location, and number of brain lesions, and outcome domain) and the neural mechanisms that altered the lesioned brain's functionality. This paper discusses Kennard's life and years at Yale (1931-1943); considers the genesis and scope of her work on early-onset brain lesions, which represents an empirical and theoretical foundation for current developmental neuropsychology; offers an historical explanation of why the 'Kennard Principle' emerged in the context of early 1970s work on brain plasticity; shows why uncritical belief in the 'Kennard Principle' continues to shape current research and practice; and reviews the continuing importance of her work.

Chapter 35: the frontal lobes

The frontal lobes occupy an exalted position in neuroscience. The largest and most recently evolved of the cerebrum's four lobes, these regions have long been regarded as harboring unique capacities most specific to the human mind. Understanding has been steadily developed, but a unitary function that captures the role of the frontal lobes has proven elusive. In antiquity, Hippocrates and Galen speculated that mental activities were located in the brain, and in the Renaissance, Leonardo and Vesalius made important advances in brain neuroanatomy. The 17th century witnessed Willis recognizing frontal brain regions, and in the 18th, Swedenborg first associated these areas with intellect. Defined neuroanatomically by Chaussier in 1807, the frontal lobes were soon assigned higher faculties by Gall and Spurzheim, and later, the case of Phineas Gage and the work of Broca clarified comportmental and linguistic dimensions of frontal lobe function. In the 20th century, progress came with Luria's observations of frontal lobe injuries and from the psychosurgery era, followed by contributions of behavioral neurology, neuroimaging, and neuroanatomy, which helped delineate frontal regions, circuits, and networks relevant to specific cognitive and emotional operations. Today, a host of important societal implications merit attention as neuroscientific investigation continues to enrich knowledge of the frontal lobes by identifying the basis of singular human behaviors.

[A terrible accident--the treatment of severe brain injury in the thirteenth century]

The remarkably modern ideas of Lanfranc of Milan (circa 1245-1315) concerning diagnosis, therapy and teaching are demonstrated by a case-history from his 'Chirurgia Magna' (AD 1296). Judging by the chapter on skull injuries, the advanced level of Lafranc's practice was not equalled by the later Middle Dutch authors such as Jan Yperman and Thomas Scellinck van Thienen.

Therapeutic hypothermia: the Safar vision

At the 2(nd) International Brain Hypothermia conference, in Miami, the late Dr. Peter Safar was honored for his many contributions to the field of therapeutic hypothermia. Therapeutic hypothermia played a central role in his overall vision for optimized resuscitation and neurointensive care, across a large number of potential insults. The successful use of therapeutic hypothermia in comatose patients after cardiac arrest, for example, was already included in the historic first "ABCs" of resuscitation, published by Safar in 1964. This review addresses key historical events in the development and implementation of therapeutic hypothermia across a number of central nervous system insults. A discussion of future potential uses of this therapy in a variety of applications as part of the Safar vision is also presented.

A neurologist's notebook: a bolt from the blue: where do sudden passions come from?

A case of musicophilia arises after a patient is struck by lighting and experiences an "out-of-body," near-death experience.

Repair of spinal cord injury: ripples of an incoming tide, or how I spent my first 40 years in research

Abstract of the inaugural lecture on appointment to the Chair of Neural Regeneration at University College London January 2006. Record of personal research. Electron microscopic observations led to the concept that the adult brain is capable of forming new synapses after injury, and the search for methods to repair brain and spinal cord injuries. It is proposed that the failure of regeneration after central axotomy is due to protective glial scarring leading to the loss of the aligned astrocytic pathways needed for axon elongation. Taking advantage of the discovery that the adult olfactory system is capable of continual renewal, cultured olfactory ensheathing cells were transplanted into lesions of the spinal cord and spinal roots. The transplants re-opened scarred glial pathways, allowed the regeneration of severed nerve fibres, and the restoration of various functions, including paw reaching, climbing, and supraspinal respiratory impulses to the phrenic nerve.

An intimate connection: Oliver Zangwill and the emergence of neuropsychology in Britain

In this article, the author argues that a number of conditions conspired to place the Cambridge psychologist Oliver Zangwill in a pivotal position for pursuing and promoting neuropsychology in Britain after World War II. In broad terms, these were the background and experience of Zangwill himself, the practical engagement of psychologists with patients with brain damage, neurologists, and psychiatrists, the introduction of medical reform including the establishment of a National Health Service, rekindled interest in cortical localization, and the elite social networks that existed in medicine and university life in postwar Britain. The author claims that the career of Zangwill reveals rather than obscures the importance of these wider conditions and demonstrates an unusually close connection between an individual and the emergence of a subdiscipline.

Ernest Hemingway: a psychological autopsy of a suicide

Much has been written about Ernest Hemingway, including discussion of his well-documented mood disorder, alcoholism, and suicide. However, a thorough biopsychosocial approach capable of integrating the various threads of the author's complex psychiatric picture has yet to be applied. Application of such a psychiatric view to the case of Ernest Hemingway in an effort toward better understanding of the author's experience with illness and the tragic outcome is the aim of this investigation. Thus, Hemingway's life is examined through a review and discussion of biographies, psychiatric literature, personal correspondence, photography, and medical records. Significant evidence exists to support the diagnoses of bipolar disorder, alcohol dependence, traumatic brain injury, and probable borderline and narcissistic personality traits. Late in life, Hemingway also developed symptoms of psychosis likely related to his underlying affective illness and superimposed alcoholism and traumatic brain injury. Hemingway utilized a variety of defense mechanisms, including self-medication with alcohol, a lifestyle of aggressive, risk-taking sportsmanship, and writing, in order to cope with the suffering caused by the complex comorbidity of his interrelated psychiatric disorders. Ultimately, Hemingway's defense mechanisms failed, overwhelmed by the burden of his complex comorbid illness, resulting in his suicide. However, despite suffering from multiple psychiatric disorders, Hemingway was able to live a vibrant life until the age of 61 and within that time contribute immortal works of fiction to the literary canon.

The risk of chronic traumatic brain injury in professional boxing: change in exposure variables over the past century

OBJECTIVES

To determine if boxing exposure has changed over time and hence if current professional boxers are at the same risk of developing chronic traumatic brain injury (CTBI) as historical controls.

DESIGN

Literature review of published studies and analysis of data of active professional boxers.

SUBJECTS

Professional boxers in the United Kingdom and Australia.

MAIN OUTCOME MEASURES

Boxing history and participation in sparring and professional bouts.

RESULTS

Since the 1930s, the average duration of a professional boxer's career has dropped from 19 years to five years, and the mean number of career bouts has reduced from 336 to 13. This is despite no significant decline in participation rates from 1931 until 2002.

CONCLUSIONS

The incidence of boxing related CTBI will diminish in the current era of professional boxing because of the reduction in exposure to repetitive head trauma and increasing medical monitoring of boxers, with preparticipation medical and neuroimaging assessments resulting in the detection of early and potentially pre-symptomatic cases of CTBI.

Brain injury and hypopituitarism: the historical background

In the year 2000, the latest review on post-head trauma hypopituitarism (PHTH) collected 367 cases of isolated or multiple deficiency of anterior pituitary hormones subsequent to traumatic brain injury. The first patient had been published in 1918 and the latest 15 were my personal observations reported in the said review. In the previous review on PHTH, which was published in 1986, a total of only 53 cases had been collected. The interest triggered by the latest review, which concluded that PHTH was indeed less rare than commonly believed, was such that a total of 192 cases have been reported from year 2000 through April, 2005.

['The rumbling of shaking brains'; the treatment of traumatic skull and brain injury in the Netherlands in the 17th century: 7 case reports from Observationes medicae by Nicolaes Tulp]

In the 17th century, several collections of medical case reports were published in the Netherlands, mostly by surgeons. The often detailed descriptions provide a good impression of medical practice in those days. One of the best-known authors of such a collection of case reports is doctor Nicolaes Tulp (1593-1674). In the latest edition of his Observationes medicae (1739), 229 cases are described, seven of which pertain to traumatic skull and brain injury. These cases provide a clear picture of the treatment of traumatic brain injury in Amsterdam in the 17th century. The cases were caused by falling objects, a fall due to drunkenness, a gunshot wound and a fall on a slippery bridge. The frequency of surgical intervention in traumatic brain injury as reported by Tulp is remarkable; he describes frequent trepanation and craniectomy for epidural and acute subdural haematoma, coagulation of bleeding vessels on the dura, removal of contused brain tissue and the operative treatment of depressed skull fractures. It may be further concluded from the descriptions that Tulp adhered to a large extent to the medical views concerning the blood circulation as described by Galenus (129-199 AD).

The exceptional brain of Maurice Ravel

This historical review describes the brain disease which afflicted the great impressionist-classicist composer Maurice Ravel (1875-1937). The usual interpretation of the symptoms Ravel exhibited during his disease is primary progressive aphasia / Pick's disease. Some authors see this as the cause for his lost musical creativity during the last years of his life. By contrast, in our review it is presented why a car accident in 1932, with the probable consequence of a mild to moderate traumatic brain injury, could be the key event in his life, triggering the loss of his ability to compose. In addition, the influence of Ravel's disease on his musical style is evaluated. Although some authors see a link, we try to explain why there is no clear evidence for this.

[Gunshot brain injury--Rishon-le-Zion 1913]

Dr. Leon Pochovski (1869-1965), the first fully trained surgeon to settle in Eretz-Israel, was summoned in 1913 from Jaffa to Rishon-le-Zion to treat a patient who sustained a tangential gunshot injury of the brain from a bullet shot at nearly point blank range, in the right occipital region. As the patient's condition deteriorated intracranial bleeding was diagnosed. Dr. Pochovski did not hesitate to operate and successfully removed an intracerebral hematoma. At first there were no visual symptoms, but on the 11th day there was hemianopia due to dysfunction of the initially uninvolved left hemisphere. It became progressed and then cleared. The hemianopia was associated with diplopia and created hallucinations in the blind field. The mode of treatment and the learned discussion of the uncommon symptomatology demonstrate that the practicing physicians were providing clinical service that did not differ in the technical standards and academic level from that of their colleagues overseas.