Neurologia Obiectul File din istorie Fenomenul durerii

Prof. Ion V. Moldovanu

Catedra de Neurologie Universitatea de Medicin i Farmacie N.Testemitanu

File din istoria neurologieiPredecesoriiNeurologiei

Predecesorii Neurologiei

Descartes formed the habit of spending the morning in bed, engaged in systematic meditation. During his meditations, he was struck by the sharp contrast between the certainty of mathematics and the controversial nature of philosophy, and came to believe that the sciences could be made to yield results as certain as those of mathematics. Predecesorii Neurologiei

1628 until his ill-fated trip to Sweden in 1649 he remained for the most part in Holland, and it was during this period that he composed a series of works that set the agenda for all later students of mind and body Predecesorii Neurologiei

Fiziologia i neuroanatomia-suportul tiinific al neurologiei clinice Fiziologia, Neurofiziologia Neuroanatomia

DR. CLAUDE BERNARD(1813-1878)

Claude Bernarde of France, early in life came under the influence of Francois Magendie (1783-1855) who was considered the father of experimental physiology in France. As a student, Bernarde touched on so many areas in physiology that he was characterized by Louis Pasteuras "Physiology Itself." From research on the pancreas, the liver, he moved on to brain lesions with metabolic concomitants. In France he shared with Johanon Frederick Horner (1831-1886)- credit for describing the so called Claude Bernarde Horner Syndrome. He did monumental work on the physiology of smooth muscle.

Sciatic nerve lesion in frog described by Berneard

DR. IVAN SECHENOV (1829-1905)

Sechenov, born in Russia, was known as the Father of Russian physiology. He introduced electrophysiology into laboratories and also into teaching. His life work was always concentrated on neurophysiology. He wrote a major classic "The Reflexes of the Brain." He also maintained that physiochemical factors in the environment of the cell are of equal if not greater importance. He was in conflict constantly with the government and his colleagues. He will also be remembered for his intellect and his knowledge, as well as for his scientific achievements.

DR. IVAN PAVLOV (1849-1936)

Born in Russia, Pavlov was educated to enter priesthood but elected to be a scientist. After earlier studies in Russia, he went to Germany for graduate work. His numerous contributions are in 4 major fields, cardiac physiology, digestion, central nervous system and psychophysiology. In his investigations of digestive glands he was awarded the Nobel prize in 1904. He developed the famous "Pavlov pouch". Also, he began to study psychology and he applied his physiological studies to this field. His book on reflexes is monumental. He was recognized as a great scientist by Russia even though he disagreed with Communism. He will be remembered as one of the great physiologists of all time.

DR. CHARLES SCOTT SHERRINGTON (1852-1957)

Sherrington was born in London, studied in England and gravitated into physiology where he was strongly influenced by Michael Foster- "father of British Physiology," by Langley and Gaskill. He also worked briefly in neuroanatomy-neuropathology. He studied the latter with Cajal and with Robert Koch. His interest was in reflexes and he is best known for his lengthy studies in spinal reflexes. Also he will be remembered for his contributions to the physiology of perception, reaction and behavior. He even wrote on the philosophic study of dualism. Drawing of overlapping neuronal fields by Sherrington

DR. CONSTANTIN VON MONOKOW (1853-1930)

Of Russian birth, he eventually studied medicine under Eduard Hitzig. Early on he was a practitioner but later he developed interest in neuroanatomy and neuropathology. He read continuously and wrote effusively with a classic outstanding Gehirnpathologie with 3000 references. Other significant publications were on lead encephalopathy, aphasia and apraxia. Together with his younger associate, Kurt Goldstein they wrote on the empiric foundation of neurology. His greatest work as a clinician was on "Die Localization in Grosshirn" and "der Abbau ler Funktion durch Korticale Herde". He introduced concepts which made present clinical neurology a truly biological science of organismal dynamics in human behavior. He also lectured on "Emotions," " Morality" and the brain.

DR. JAMES PAPEZ (1883-1958)

Born in the United States, Papez after receiving his MD at the University of Minnesota College of Medicine and Surgery entered into neuroanatomy training and authored his book "Comparative Neurology" in 1929 patterned after his famous course of neuroanatomy when he later worked at Cornell in Ithaca, New York. He was a great teacher as he was a writer. A great interest was paralysis in which he studied the neuropathology. He conceived a "mechanism of emotion" (hypocampo-thalamo-cingulate-hippocampal circuit). Papez will be remembered as one of the great neuroanatomists of all time.

Neurologia Clinic Naterea Neurologiei Fondatorii Neurologiei

Charcot Jean-Martin*29 noiembrie 1825 - 16 august 1893

ntre anii 1862 i 1870 J-M Charcot constituie bazele unei noi discipline medicale:

Neurologia

1882 crearea catedrei de boli nervoaseFondatorul neurologiei mondiale

DR. JEAN MARTIN CHARCOT*(1825-1893)

In the contribution to neurosciences by France, this country claims the medical genius of them all. Charcot, whose brilliance as a clinician and a neuropathologist could never be surpassed. He created neurology as a firm discipline, made monumental studies in tabes, described, arthropathies "Charcot Joints", Amyotrophic Lateral Sclerosis, was not only described but was named by him. His name comes forth as contribution to the knowledge of poliomyelitis, neuropathies (Charcot-Marie-Tooth) disease, nuiliary aneurysms, ankle clonus. He even wrote on hysteria, "blessed" hypnotism and was involved early on in the conflict over animal experimentation. He was a great teacher and many of his students became the "greats" in neurology. It has been said that Charcot entered neurology in its infancy and left it at its "coming of age."

DR. JOSEPH FRANCOIS FELIX BABINSKI*(1857-1932)

Babinski, of French descent, had a thorough training in general medicine before entering the study of neurology. His bibliography is

lengthy beginning with a treatise on typhoid fever (1882) and ending with a study on hysteria (1930). He worked with the great in neurology in France to include Charcot, Brissaud, Pierre Marie, Dejerine and others. He described in 1903 the associated fanning of the toes which would later be termed Babinski Sign. He also published on cerebrospinal syphilis, cerebellar signs and symptoms such as asynergia adiadochokinesia, on reflexes, on unilateral bulbar lesions and dystrophia adiposogenitalia. Babinski anticipated the neurosurgical era approaching France and of 2 of his favorite students- de Martel and Vincent he stated "I showed them the way to found French neurosurgery."

DR. SIGMUND FREUD(1856-1939)

Neurolog german conceptul incontientului fondatorul psihanalizei

DR. CHARLES LASGUE (1816-1883) Born in France, Lasgue studied medicine and early on was a clinician. But while working at the Salpetriere his interest turned to neurology- even to psychiatry which was initially his forte. He wrote on hysteria, delusions, folie-a-deux, catalepsy, even exhibitionism. He wrote a classic work on Les Cerebraux dealing with vascular disturbances of the brain. The Lasgue sign ascribed to him although there is some dispute that others preceded him in their descriptions. He was a great friend of the arts.

DR. HUGHLINGS JACKSON (1835-1911)

Born in England, Jackson first became interested in neurology when he became a staff member of the National Hospital Queens Square. There began his first stimulation in the study of seizures. He gained importance, not on his description of a certain seizure pattern "Jacksonian Epilepsy," but on his formulation of concepts even principles that explain paroxysmal seizures of all types. He also postulated truly evolutionary levels of the sensori-motor mechanisms-the lowest spinal cord, medulla and pons, the middle, the rolandic region, and the highest level, the prefrontal lobes. As a neurologist, he published some 300 papers mostly in obscure journals.

Alexsei Cojevnicov* (1836 1902)

Creaz coala ruseasc de de neurologie,catedra de neurologiesocietatea de neurologie Epilepsia CojevnicovElevii lui au fost :Rot, Darksevici, Rossolimo, KorsakovFondatorul colii ruseti de neurologie

DR. VLADIMIR MIKHAILOVICH BECKHTEREV*(1857-1927)

This young Russian scientist was, early on, involved in psychiatry moved at the end of the nineteenth century into the study of anatomy, psychology and pathology of the nervous system and was privileged to become a student of the great Flechsig in Leipzig when he described the superior vestibular nucleus which bears his name. He also studied the relationship between the brain and behavior as an anatomist. He made studies on reflexes and on the cortical representation of visceral functions of blood pressure of pupillary, gastrointestinal, urovesical and anorectal mobility and of glaudular secretory activity.

DR. G.T. ROSSOLIMO Rossolimo of Russian birth, in 1902 described his signs which is pathologic pyramidal trait sign. It is positive when the balls of the toes are tapped briskly with the finger resulting in plantar extension or spreading of the toes.

Gheorghe Marinescu* (28 februarie 1863 15 mai 1938)

1897 actul de natere a tiintei neurologice romneti se creaz Catedra clinic a maladiilor nervoase

Fondatorul colii romaneti de neurologie

Gheorghe Marinescu*1863 -1938

Lucrarile principale: "Studii asupra evolutiei si involutiei celulei nervoase" (1900), "Celula nervoasa" (1909), "Encefalita letargica" (1920), "Reflexele conditionate", impreuna cu A. Kreindler (1936). Marinescu'shand , a cold blue oedematous hand with lividity of the skin seen in neurological lesions such as syringomyelia . Marinescu-Sjgren-syndrome , a rare congenital disorder with spinocerebellar ataxia,congenital cataract, short stature, mental retardation and some skeletal deformity. Kinn reflex (Marinescu-Radovici) , in some patients presenting with pyramidallesions.

fondatorul scolii romnesti de neurologie

printre primii din lume a aplicat in neurologie metode histologice si histopatologice si metoda anatomoclinica in cercetarea stiintifica teoria troficitatii reflexe reflexul palmo-mentonier localizarilor nucleul nervului pneumogastric, al nervului facial regenerare SN la bolnavii de tabes leziunile neuronilor motori in SLA propagarea virusului poliomelitic si a celui herpetic in SNC, a cercetat infectia zosteriana experimentala reflexelor conditionate in studiul isteriei, al epilepsiei, al afaziei, al nevrozelor.

1897 fondarea Catedrei de clinica maladiilor nervoase

1945 -2005

Catedra de Neurologie 60 ani Scurt schi istoric Catedra de Neurologie alma mater a neurologiei autohtone

1945 -2005

Catedra de neurologie a fost fondat n octombrie, 1945, de profesorul Boris arapov, unul dintre discipolii strluciilor corifei ai tiinei neurologice ruse din Sanct-Peterburg L.V.Blumenau i S.N.Davidencov.

B.I.arapov a condus catedra n perioada anilor 1945-1953 i 1956-1969, fcnd ntrerupere, trei ani lucrnd n funcie de ef catedrei de neurologie al Institului de Medicin din Odesa. n aceast perioad au condus catedra confereniarul P.Varno (1953-1954) i profesorul S.Ahundov (1954-1956).

Catedra de Neurologie 60

1- pr.Kornilov 2-pr.Lvov 3-pr.Koceghinschii 4-pr.Haruzov 5-pr.Cecurin 6- pr.Borzov 7 8 9 10Catedra de Neurologie 6012 345 6

Catedra de Neurologie 60n anii 50 colaboratorii ai catedrei au fost: I.Orentein, B.Bromberg, E.Baiburt.Printre primii neurologici, care au trecut perfecionarea n clinica de neurologie, au fost S.Sirchis, L.Hanina, A.Donscaia, M.Coblic.Sub conducerea profesorului B.arapov au fost pregtii 6 doctori habilitai i 12 doctori n medicin. Numeroii si discipoli au activat n calitate de specialiti principali, au condus clinici neurologice (profesorii P.Lecari n Sanct- Peterburg, P.Areev i A.Glaurov n Simferopoli, I.Curaco n Odesa, A.Nacu, D.Gherman n Chiinu).

Profesorul B.arapov a pus bazele tiinifice ale catedrei, iniind o serie de cercetri, consacrate manifestrilor clinice i morfopatologice ale traumelor cerebrale i medulare nchise 1947 prima culegere de lucrri tiinifice efectuate la catedr B.arapov, Schie clinice i morfologice ale formaiunii reticulare cerebrale (1965)

Elevii lui arapov i lucrrile lor: E.Baiburt - schimbrile encefalului i ale mduvei spinrii n urma traumei ganglionilor simpatici cervicali. P.Lecari - degenerescena hepato-lenticular. D.Gherman - de doctor n medicin Cu privire la anatomia i patogenia arahnohidromieliei posttraumatice. B.Ianachevici a demonstrat importana formaiunii reticulare n patogenia aa-numitei traumei craniocerebrale nchise uoare(REG) V.Pslaru teza de doctor n medicin traume experimentale pe animale: modificrile formaiunii reticulare n poriunea caudal a trunchiului cerebral. M.Casian teza de doctor n medicin lezrii formaiunii reticulate n perioada acut a ictusului cerebral A.Voloh- teza de doctor n medicin: leziunea formaiunii reticulate n caz de etilism.

Prof. arapov la 70 ani

Gheorghe Marinescu1863 -1938 fondatorul scolii romnesti de neurologieLucrarile principale: "Studii asupra evolutiei si involutiei celulei nervoase" (1900), "Celula nervoasa" (1909), "Encefalita letargica" (1920), "Reflexele conditionate", impreuna cu A. Kreindler (1936). Marinescu'shand , a cold blue oedematous hand with lividity of the skin seen in neurological lesions such as syringomyelia . Marinescu-Sjgren-syndrome , a rare congenital disorder with spinocerebellar ataxia,congenital cataract, short stature, mental retardation and some skeletal deformity. Kinn reflex (Marinescu-Radovici) , in some patients presenting with pyramidallesions.

printre primii din lume a aplicat in neurologie metode histologice si histopatologice si metoda anatomoclinica in cercetarea stiintifica.un deschizator de drumuri in cercetarea histologiei normale si patologice a sistemului nervos teoria troficitatii reflexe reflexul palmo-mentonier localizarilor nucleul nervului pneumogastric, al nervului facial etc. fenomenele de regenerare din maduva spinarii la bolnavii de tabes, leziunile neuronilor motori in scleroza latarala amiotrofica etc. urmarind propagarea virusului poliomelitic si a celui herpetic in sistemul nervos central, a cercetat infectia zosteriana experimentala etc. a studiat fermentii oxidativi, localizarea lor in corpul celulelor, fiziologiei si fiziopatologiei SN utilznd EEG metoda reflexelor conditionate in studiul isteriei, al epilepsiei, al afaziei, al nevrozelor.

cola rus de neurologie

D.Gherman continu cu succes cercetrile tiinifice, activitatea pedagogic i medical a predecesorului su O rezonan mare au cptat rezultatele cercetrilor tiinifice n domeniul dereglrilor vasculare cerebrale i medulare. Manifestrile clinice, patogenia, morfopatogenia i tratamentul acestor dereglri i-au gsit o ampl dezvluire n teza de doctor habilitat n medicin lui D.Gherman, iar mai trziu n monografia lui intitulat Dereglrile vasculare medulare ischemice (1972) Unele aspecte ale acestei probleme au fost reflectate i n teza de doctor n medicin lui T.Botnaru, precum i n cele lui M.Gavriliuc, O.Pascal, V.Lisnic, I.Sorocean, M.Sangheli efectuate sub ndrumarea tiinific a profesorului D.Gherman.

Una din problemele actuale ale neurologiei, efectuate la catedr, o constituie patologia coloanei vertebrale. Rezultatele cercetrilor n acest domeniu au stat la baza tezei de doctor n medicin E.Chetraru Spondilopatia hormonal, care mai trziu s-a ncadrat n monografia lui D.Gherman i E.Chetraru Spondilopatia hormonal, monografia Radiculita lombosacral spondilogenic, scris de colectivul de autori D.Gherman, D.Bogorodinschi, A.Scorome, O.Godovanik.n anul 1969 eful catedrei de neurologie devine D.Gherman elevul lui B. arapov

Patologia vascular medularInvestigaiile tiinifice n aceste importante direcii ale neurologiei au continuat. Au aprut monografiile: Tulburrile vasculare medulare (D.Gherman, A.Scorome, 1981), Ischemii radiculomedulare (D.Gherman, A.Scorome, 1982), Neuropatii de tunel (D.Gherman, A.Scorome, N.Irecaia, 1989).n 1945, din iniiativa profesorului B.arapov, a fost organizat Societatea tiinific a neurologilor din Moldova, a crei preedinte a activat pn la 1969. Succesorul lui este profesorul D.Gherman. Din momentul fondrii pn azi societatea a organizat numeroase congrese, conferine, simpozioane unionale i internaionale. Materialele acestor foruri tiinifice au fost editate n 11 culegeri de lucrri tiinifice.n 1962 baza clinic a catedrei a fost extins pn la numrul de 120 paturi, datorit drii n exploatare a cldirii dispensarului de psihoneurologie. Tot la aceast baz a fost transferat i secia de neurochirurgie, care pn atunci se afla n localul Spitalului Republican de Psihiatrie. n aa mod a fost creat o clinic unic de neurologie i neurochirurgie pe lng Spitalul Clinic Republican de Psihiatrie, care din 1979 trece n subordonarea Spitalului Clinic Republican.n 1968 n cadrul catedrei de neurologie a fost deschis cursul de genetic uman, iar din 1972 cursul de neurochirurgie, condus de confereniarul V.Ra.

Catedra de neurologie fondat n 1945 ef profesorul B.arapovCatedra de neurologie i neurochirurgie cu curs de genetic medical fondat n 1971ef profesorul D.GhermanCatedra de neurologie

ef profesorul I.MoldovanuCatedra de neurologie i neurochirurgie cu curs de genetic medical fondat n 1995

ef profesorul S.GroppaCurs de neuropediatrie fondat n 1995

ef profesorul I.IlciucCatedra de neurochirurgie fondat n 2000

ef profesorul G.ZapuhlhCurs de genetic medical fondat n 2001

DR. JEAN MARTIN CHARCOT(1825-1893)

Salpetriere Opera lui Charcot contine mai mult de 700 publicatii (13 volume) paralizie agitanta sau maladia Parkinson ucrari consacrate gutei paraplegiei dureroase la cancer

- anatomia i fiziologia sistemului nervos - patogeneza hemoragiei cerebrale 1868 1869u scleroza laterala amiotrofica (maladia Charcot) - precizeaza semiologia sclerozei n paci

n 1998 conducerea catedrei de neurologie i neurochirurgie cu curs de genetic medical a fost preluat de unul din discipolii catedrei prof. I.Moldovanu.Aa dar catedra de neurologie, fondat de savantul rus Boris arapov 1946-1969, condus timp de 30 ani de discipolul lui academicianul D.Gherman, a dat natere unei catedre de neurologie, unei de neurochirurgie i 2 cursuri de neuropediatrie i genetic medical. Aceast divizare a declanat un lucru tiinific i mai amplu. Din momentul divizrii 1995 s-au susinut dou teze de doctor habilitat (M.Gavriliuc, G.Zapuhlh) i 8 teze de doctor n tiine medicale; la catedra de neurologie a facultii de perfecionare postuniversitar au fost susinute 3 teze de doctor n tiine; la cursul de neuropediatrie - 2 teze de doctor n tiine; la catedra de neurochirurgie a fost susinut o tez de doctor n tiine. La catedra de neurologie se pregatesc de susinere dou teze de doctor habilitat (V.Lisnic, R.Baltag). S-au activizat legturile internaionale cu rile dezvoltate, mai ales cu Frana (1 Conferin tiinifico-practic Neurologic Moldo-Francez) i Germania (10 Conferine neurologic-neurochirurgicale Moldo-Germane, o Conferin Moldo-German Neurologic). n 1996 a fost organizat Liga de combatere a epilepsiei, condus de profesorul S.Groppa, care a petrecut 3 Conferine tiinifico-practice cu specialitii din Germania. n 1997 au fost organizate Asociaia de studiu al cefaleelor (a petrecut 3 Conferine tiinifice) i Asociaia de Psihanaliz i Psihosomatic din Moldova (4 Conferine tiinifico-practice), conduse de profesorul Ion Moldovanu.

Ultimii ani sunt marcai de o activitate tiinific i didactic activ realizat de ctre colaboratorii catedrei de neurologie ntr-un context de relaii internaionale. Au fost organizate i petrecute cu succes la Chiinu 2 Cursuri educaionale n cadrul Federaiei Europene a Societilor Neurologice (2001,2003), Simpozionul Iai-Chiinu (2003). Colaboratorii catedrei conf.V. Lisnic i O.Pascal, prof. M.Gavriliuc au petrecut stagiuni n SUA, Anglia, iar eful catedrei prof. I. Moldovanu a activat ca prof invitat n Frana (Grenoble, Paris) n 1997 i 1998 i a petrecut un stagiu clinico-tiinific de 6 luni (2002-2003) n Clinica Mayo Scottsdale (SUA) n cadrul unui Program Fulbright. Activitatea tiinific a catedrei se manifest i prin participarea activ la diverse foruri tiinifice naionale i internaionale, prin invitarea specialitilor pentru diverse tipuri de colaborri tiinifice.

Aa dar catedra de neurologie, fondat de savantul rus Boris arapov 1946-1969, condus timp de 30 ani de discipolul lui academicianul D.Gherman, a dat natere unei catedre de neurologie, unei de neurochirurgie i 2 cursuri de neuropediatrie i genetic medical. Catedra de neurologie fondat n 1945ef profesorul B.arapovCatedra de neurologie i neurochirurgie cu curs de genetic medical fondat n 1971ef profesorul D.GhermanCatedra de neurologie i neurochirurgie cu curs de genetic medical fondat n 1995ef profesorul S.GroppaCurs de neuropediatrie fondat n 1995ef profesorul I.IlciucCatedra de neurologieef profesorul I.MoldovanuCatedra de neurochirurgie fondat n 2000ef profesorul G.ZapuhlhCurs de genetic medical fondat n 2001

DR. JEAN MARTIN CHARCOT (1825-1893) 1862 ncepe activitatea sa la Salpetriere fiind numit ef de serviciu n cartierul batrnete femei. n acea perioada n ospiciul de la Salpertiere se aflau circa 5000 pacienti ,un vast pandemonium al mizeriei umane,fiind un imens rezervuar de cronici (Charcot) Opera lui Charcot contine mai mult de 700 publicatii (13 volume) n 1861 1862 el prezinta mpruna cu Vulpian o observatie de paralizie agitanta sau maladia Parkinson 1963 - lucrari consacrate gutei 1865 - cercetari asupra paraplegiei dureroase la cancer - anatomia i fiziologia sistemului nervos - patogeneza hemoragiei cerebrale - lectii la tema maladiilor pulmonare,hepatice,descrierea lobulilor pulmonari i hepatici 1868 1869 - descrierea sclerozei primitive a cordoanelor laterale sau scleroza laterala amiotrofica (maladia Charcot) - precizeaza semiologia sclerozei n paci deosebind cele mai principale simptome conferindui maladiei o veritabila identitate

Structurile senzitive (sistemul aferent) al n. trigemenII neuron lemniscusul medial III neuron cortexIII neuron

Lengthy- lung, foarte lungDelusion iluzii