Functional magnetic brain imaging (fMRI) is a method that allows us to study the workings of the human brain while people perceive, reason and make decisions. The principle on which it is based is that, when nerve cells or neurons in a particular region become active, there is an increase in the blood supply to that brain area. This can be visualized because the scanner can be sensitized to the changes in the blood oxygen level that occur when the nerve cells become active.
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To mark this month’s release of Martin R. Turner and Matthew C. Kiernan’s Landmark Papers in Neurology, we spoke with the two editors, to discuss their thoughts on neurology – past and present. We asked about the origins of neurology, the understanding of neurological diseases, milestones in the field, why historical context is so important – and their predictions for the future…
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In the wake of the development of advanced neonatal intensive medical care, more and more children born very preterm manage to beat the previously tough odds and survive the perils of infections and respiratory distress that are some of the common problems in the group. While this is one of the success stories of modern medicine, long-term follow-up of premature-born pediatric cohorts show that the obstacles don’t cease with the need of intensive medical care.
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Purple Day started with the curiosity and of a girl in eastern Canada, in the province of Nova Scotia, who had epilepsy. It soon became a world-wide success. Purple Day is now an international initiative and effort dedicated to increasing awareness about epilepsy around the globe. Why is it so important to create awareness around people with epilepsy?
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Tomorrow, 8 November, will mark the third anniversary of the now established International Day of Radiology, an event organised by the European Society of Radiology and Radiological Society of North America: a day in which health care workers worldwide mark their debt of gratitude to Wilhelm Roentgen’s great discovery of x- rays, and its subsequent applications in the field of medical practice, today known as radiology or medical imaging. On 8 November 1895, Roentgen conducted his seminal experiment, which was to change the world forever and earn Roentgen the first Nobel Prize for Physics. This day now is celebrated by over one hundred learned radiology societies worldwide to promote the importance of this discipline in current medical practice, a discipline which has changed beyond wildest recognition from the early days of the pioneers and radiation martyrs. The day is a celebration of all radiology team members’ contribution to patient care. In the early days of this new discipline practitioners were not confined to members of the medical profession but included any lay interested member of the public. Only with the passage of time did the discipline of radiology become the sole preserve of medical practitioners, with appropriate training and regulation introduced to raise standards.
It is interesting to note that the first multidisciplinary society devoted to the new subject ‘The Roentgen society’ was founded in 1897 in London by David Walsh, F.E. Fenton, and F. Harrison Low. In the summer of that year, Professor Silvanus Thompson, the physicist, Fellow of the Royal Society of London, brilliant lecturer, populiser of science, prolific author, and true Victorian polymath became its inaugural President. It has since metamorphosed into the current British Institute of Radiology.
One of the celebratory themes of this year’s International Day of Radiology is brain imaging. The immediate early application of x-rays was to look for fractures and localise foreign bodies, leading to their application in the military setting. In the early days, x-rays did not allow doctors to directly visualise the brain. Arthur Schueller, the Viennese radiologist who worked closely with G. Holzknecht, became an early pioneer in using x-rays to make neuroradiological diagnosis and help neurosurgeons deal with brain tumours.
Although the brain itself could not be seen by x-rays, secondary signs from tumours often showed, such as erosion of the skull bones. Localisation of tumours was not an exact science and early detection was difficult. The American Walter Dandy, who worked at Johns Hopkins Hospital, pioneered the imaging of the ventricles by introducing air and contrast, this assisted surgeons in localising tumours of the brain by looking for ventricular displacement. It is claimed that the great Pulitzer Prize-winning neurosurgeon Harvey Cushing thought that this technique would take the skill out of making a diagnosis by clinically examining the patient, though by today’s standards, a clinical examination would not be considered a pleasant investigation to have.
In Portugal in the late 1920s the polymath Egaz Moniz pioneered cerebral angiography, enabling doctors to visualise the blood supply to the brain, including tumours; this was a great step forward. Moniz was an author, researcher, was at one time Portuguese Foreign Secretary, and was also awarded the Nobel Prize in 1949 for his medical advances. However, a really great leap in brain imaging occurred in the early 1970s, when CT scanning (invented by the British genius Hounsfield) came of age, enabling doctors to visualise the brain itself, along with Magnetic Resonance Imaging (MRI) in the 1980s, further clarifying the workings of the normal and abnormal brain.
Today diagnostic imaging, including the more sophisticated CT scanners, are available even in less affluent countries, and their applications and uses in patient care continues to multiply. They have replaced some of the earlier, more dangerous and uncomfortable investigations endured by the preceding generations of patients. More affluent nations continue to see an exponential growth in modern radiological investigations; such is our fascination for high technology.
Today we salute the pioneers in radiology whose efforts have left us with safer, more accurate and more patient friendly tests than ever before. To find our more about International Day of Radiology and its activities, visit the website.
Heading Image: © Nevit Dilmen, Rad 1706 False colour skull. CC BY-SA 3.0 via Wikimedia Commons.
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