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Chapter 5 - The Making of a Specialty

Published online by Cambridge University Press:  06 January 2022

Michael J. Aminoff
Affiliation:
University of California, San Francisco
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Summary

James B. was a Scottish lad of twenty-two with focal epilepsy when he entered into the medical history books. He had been run over by a cab when seven years old, sustaining a depressed, compound skull fracture to the left of the vertex that led to a loss of brain substance and local infection. He developed seizures at the age of fifteen, and these became increasingly frequent and sometimes occurred in flurries such that he experienced as many as three thousand fits over a two-week period. They most commonly started in the right leg:

The right lower limb was tonically extended, and the seat of clonic spasm. The right upper limb was then slowly extended at right angles, to the body, the wrist and fingers being flexed; the fingers next became extended, and clonic spasms of flexion and extension affected the whole limb, the elbow being gradually flexed. By this time, spasms in the lower limb having ceased, but those in the upper limb continuing vigorously, spasm gradually affected the right angle of the mouth, spreading over the right side of the face, and followed by turning of the head and eyes to the right.

To sum up, the parts affected were so in the order of lower limb, upper limb, face, and neck; the character of the movements was, first, extension, then confusion, finally, flexion, showing clearly that the focus of discharge was situated around the posterior end of the superior frontal sulcus [italics added].1

The epileptic focus was thus localized based on principles derived from experiments in animals, and its site coincided with that of a scar on the scalp and an associated bony defect in the skull.

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Information
Victor Horsley
The World's First Neurosurgeon and His Conscience
, pp. 52 - 60
Publisher: Cambridge University Press
Print publication year: 2022

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References

Notes

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