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How did stroke become of interest to neurologists?

A slow 19th century saga

From the Stroke Unit and Division of Cardiovascular Medicine (M.P.), University of Perugia, Italy; and Department of Neurology and Neurorehabilitation (J.B.), Swiss Medical Network, Valmont-Genolier, Glion sur Montreux, Switzerland.

Address correspondence and reprint requests to Dr. Maurizio Paciaroni, Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia 06126, Italy mpaciaroni{at}med.unipg.it.

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 Salpêtrière and Pitié 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 Déjerine and Marie, and followed by Foix, the father of modern clinical stroke research.

Disclosure: Author disclosures are provided at the end of the article.

Received February 23, 2009. Accepted in final form May 19, 2009.

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