HOW DID STROKE BECOME OF INTEREST TO NEUROLOGISTS? A SLOW 19TH CENTURY SAGA

Abstract

It was not until the first half of the 19th century that the vascular nature of strokes was readily recognized and accepted. Brain "softenings" were distinguished from hemorrhagic "apoplexy," but stroke etiology remained unstudied. The terms artherosclerosis, thrombosis, embolism, and lacune were introduced to indicate etiology, but carotid occlusive disease was recognized later, in the second half of the 19th century. The development of knowledge of stroke was slow, likely corresponding to limited interest by the great early neurologists: stroke never was a field of critical interest in the Salpetriere and Pitie Schools at the time of the local leading figures, Vulpian and Charcot. By contrast, scarce studies were due to isolated physicians, who did not contribute much to other fields, including Rochoux, Rostan, Durand-Fardel, or Dechambre; critical advances came from pathologists such as Rokitansky and Virchow. The interest in stroke among neurologists generally was clearly triggered by the development of clinical-topographic correlation studies, promoted by Dejerine and Marie, and followed by Foix, the father of modern clinical stroke research.