Charcot and Cholesterin

We offer here an observation written in 1866 by Jean-Martin Charcot, accompanied by drawings made during the autopsy of a patient who died of "cerebral softening." Focusing mainly on French medical progress at the time, our survey of the state of knowledge of cerebrovascular pathology indicates that Charcot completely explained the pathophysiology of cerebral infarction, describing the ulceration of an atheromatous plaque at the intima of an artery, on which a clot aggregates, blocks the vessel, or releases embolus downstream, causing cerebral ischemia and parenchymal lesions. Using the term "cholestérine" (cholesterin), the name of cholesterol at the time, he identified the biological nature of atheromatous plaques, and made detailed drawings. This observation, included in the famous thesis of Ivan Poumeau, indicates that Charcot did not neglect cerebrovascular pathology, ischemic in this case, but also pathology caused by hemorrhaging, as in the thesis of Charles Bouchard. This interest, which we see clearly during his first decade at Hôpital de la Salpêtrière, gradually turned toward other neurological pathologies that ensured his fame as a founder of neurology more enduringly and overshadowed the conceptual advances he made in the vascular domain.

Tumor-like coronary atheroma: a modern coronary evaluation with a historical perspective

The concept that atherosclerotic disease could be a form of neoplasm has been proposed in the medical literature for centuries, yet few modern cardiologists or pathologists describe atherosclerotic plaques as having the appearance of tumors. Although atherosclerosis is now considered to be an inflammatory disease, parallels between the pathophysiologic courses of atherosclerosis and neoplasia have been described since the 19th century. Current research is increasingly focused on mechanisms common to both diseases.Herein, we present the case of a 70-year-old man with a tumor-like coronary atheroma that was diagnosed on computed tomographic coronary angiography and confirmed with the use of intravascular ultrasound. However, the large plaque was not apparent on conventional invasive angiography. This case serves as a reminder of the limitations of invasive angiography and of the superiority of both computed tomographic coronary angiography and intravascular ultrasound in identifying and quantifying coronary plaque. We discuss our interpretation of the patient's lesion and review various theories of atherogenesis.