The long shadow of cerebral localization

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In 1995, during my first week as a neurology resident at Massachusetts General Hospital, I had the privilege of meeting the late Raymond Adams. He was an established octogenarian by then, but the years had made no difference to his air of professionalism and academic authority. His reputation was made in the 1950s and 1960s, when he developed Boston as a major centre of clinical neurology. Among other things, he is immortalized through a famous textbook that has appeared in multiple editions. Our meeting took place at a clinical conference in which I was required to present a case. He was a demanding clinician, and my neurological examination did not meet his standards of thoroughness. Despite my best efforts, I could not remove the look of displeasure from his face. I defended myself, invoking time efficiency and what not, but Dr Adams was unforgiving. 'You can't rush a neurological examination,' he said. 'A proper one takes three days.' Dr Adams was, of course, echoing a mindset that goes back to the very foundations of neurology. In 1875, Jean-Martin Charcot had delivered a series of lectures to the Paris Medical School on cerebral localization, laying out a method that sought clinical alliance between pathological cerebral lesions and clinical signs in living patients. He was already much more than a professor by then, his profile and personality was compared to Napoleon and Caesar. He was also well into a legendary career at the Salpêtrière Hospital that would enshrine him as the father of neurology. The method of cerebral lesion localization became the founding pillar of neurology as a clinical discipline. It is a powerful diagnostic tool that permits reasonably accurate spatial localization of a lesion within the nervous system without resort to technology. The benefits are obvious. The problem, unfortunately, is that lesion localization became an end in itself.


Journal of the Royal Society of Medicine