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The first description and naming of the hippocampus is usually credited to Arantius (c. 1530 - 1589), whose comparison of the swelling inside the temporal horn of the lateral ventricle to a seahorse (hippocampus) or silkworm (bombyx) was published in the 1587 edition of the Anatomicarum Observationum Liber. However, in the 17

Introduction: A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. Methods: We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. Results: Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. Conclusion: The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

Tabes dorsalis, a late neurological complication of syphilis, is nowadays almost extinct. The path to understanding this disease and its pathophysiology was long and winding, spanning multiple centuries. The 19th century was a crucial period for understanding it. In the first third of the century, German and French physicians defined the semiology of tabes dorsalis, renamed in France "ataxie locomotrice progressive [progressive locomotor ataxia]." Nevertheless, the multiplicity of ancient and recent terms and the description of sometimes unclear nosological concepts (tabes nervosa, tabes spasmodic, nervo-tabes, etc.) were a hindrance to understanding it. Tabes dorsalis was a fertile ground for the description of many clinical signs that have become classics in medicine. No real treatment was available and various unusual therapies were performed. For a long time, the etiology of this disease remained unknown. The link between syphilis and tabes dorsalis was slowly established in the second part of the 19th century from epidemiologic observations. We present an overview of the concept of tabes dorsalis in the medical context of the 19th century and discuss the medical observations of some famous patients suffering from the disease such as Edouard Manet (1832-1883) and Alphonse Daudet (1840-1897).

Objective The main objective of this study was to define and verify anatomo-sonographic landmarks for ultrasound-guided injection of botulinum toxin into the longissimus capitis (LC) and splenius cervicis (SC) muscles. Methods and results After a preliminary work of anatomical description of the LC and SC muscles, we identified these muscles on two cadavers and then on a healthy volunteer using ultrasound and magnetic resonance imaging (MRI) to establish a radio-anatomical correlation. We defined an anatomo-sonographic landmark for the injection of each of these muscles. The correct positioning of vascular glue into the LC muscle and a metal clip into the SC muscle of a fresh cadaver as verified by dissection confirmed the utility of the selected landmarks. Discussion For the LC muscle, the intramuscular tendon of the cranial part of the muscle appears to be a reliable anatomical landmark. The ultrasound-guided injection can be performed within the cranial portion of the muscle, between the intra-muscular tendon and insertion into the mastoid process at dens of the axis level. For the SC muscle, the surface topographic landmarks of the spinous processes of the C4–C5 vertebrae and the muscle body of the levator scapulae muscle seem to be reliable landmarks. From these, the ultrasound-guided injection can be carried out laterally by transfixing the body of the levator scapulae. Conclusion The study defined two cervical anatomo-sonographic landmarks for injecting the LC and SC muscles.

Shoulder pain or paresis should be assessed carefully, as there are many possible causes, which can be osteoarticular, degenerative, inflammatory, or neurological. Weakness or pain can be related to cervicobrachialgia, plexitis, or focal mononeuropathy. The clinical picture should identify any muscular or mechanical origin of paresis responsible for pseudo-paretic functional limitation. Neurogenic scapulalgia with functional deficit implies the compression or entrapment of a nerve trunk including the axillary, long thoracic, accessory, suprascapular, or dorsal scapular nerves. Nerve conduction study and myography together with medical imaging help to identify the relevant etiology. Treatment mostly includes pain relief and physiotherapy, but surgery is rarely necessary.L’épaule douloureuse ou parétique est d’appréhension délicate et de causes variées : ostéoarticulaire, dégénérative, inflammatoire ou neurologique. La faiblesse ou la douleur peuvent être liées à une cervicobrachialgie, une plexite ou une mononeuropathie focale. Le tableau clinique doit distinguer une parésie d’origine musculaire ou mécanique responsable alors d’une limitation fonctionnelle pseudo-parétique. Une scapulalgie déficitaire neurogène implique la recherche d’une mononeuropathie d’enclavement ou compressive d’un tronc nerveux, axillaire, long thoracique, accessoire du XI

Background: For many years, neurology was seen as a purely observational discipline, focused on pathology and with little interest in treatments. Summary: From the creation in 1897 of Monatsschrift für Psychiatrie und Neurologie, the forebear of European Neurology, to nowadays, there have been great changes in the paradigms and concepts of treatments in neurology. We present an overview of the evolution of neurological treatments from 1897 to 2022. Key Messages: However, the last 125 years have not consisted of constant progress. The exceptional advances made in some diseases (multiple sclerosis or surgical treatment of Parkinson’s disease) cannot hide the stagnation in others (certain brain tumors or amyotrophic lateral sclerosis).

Although multifocal motor neuropathy (MMN) is now recognized as a distinct, albeit rare, neurological condition, the path to its recognition was long and winding. This article provides an insight into the medical history of MMN “patient zero” and the first scientific publication that led to the recognition of MMN by the medical community. Multifocal motor neuropathy is nowadays recognized as a disease that produces asymmetric muscle weakness and cramping, with spontaneous motor unit activity (fasciculations and myokymia) but without sensory disorder. From an electrophysiological point of view, the neuropathy is characterized by persistent conduction blocks that usually initially affect the proximal upper extremity. The path to recognizing this rare entity was long and winding. In this article, we describe the first known patient suffering from this disease and the scientific context of its emergence, leading to the first publication on the subject, written by Gérard Roth (1923–2006) and his colleagues at the Neurology Department of Geneva University Hospital (Switzerland) [Eur Neurol. 1986;25(6):416–23].

Patients with cervical dystonia (CD) may present with head and/or neck movements in the coronal, sagittal or transverse plane. According to the Col-Cap concept, CD postures are classified in torti-, latero-, ante- and retrocollis/caput patterns. The frequency of these different subtypes has to be evaluated. Between January and June 2019, we examined 306 patients (55.5 ± 13.1 years, 67% female) with CD according to the Col-Cap concept. They were all treated with botulinum toxin. This prospective study took place in seven different movement disorder centers. The most common primary form was torticaput (49%), the second most common was laterocaput (16.7%). All other subtypes were less than 10% of the study population. Pure forms were observed in 16.3% of patients only. Torticaput was combined in 46% with laterocaput, and in 20.7% with retrocaput. Laterocaput was combined mainly with torticaput (45.1%), laterocollis (33.2%) or retrocaput (23.5%). Shift forms were found in 14.7%, but diagnosed only in 3.9%. On average, the patients had 2.51 (± SD 1.09) subtypes each. Tremor was observed in 55.6%. The mean number of injected muscles was 4.4 (SD 1.6). The most often injected muscles were splenius capitis (83%), sternocleidomatoideus (79.1%), and upper trapezius (58.5%). This is the first multicenter study to examine the frequency of different subtypes of CD according to the Col-Cap concept. The caput subforms are more common than the cervical types, with torticaput as the most common one. Shift forms were diagnosed less often than described. Pure forms are very rare, combinations of 2-6 subtypes are common (83.7%). Sternocleidomatoideus, splenius capitis and trapezius muscles were still injected most often, but the muscles rarely injected in the past such as levator scapulae (48.7%), obliquus capitis inferior (35.3%) and longissimus (16.7%) were considered quite often. Since optimal therapy results depend on the injection of the right muscles, the correct classification should optimize the treatment outcome.

Stroke-related restless legs syndrome (sRLS) secondary to ischemic lesions is an emerging entity and an interesting condition, but there are limited available data to help us further understand its underlying pathways. In this study, we characterized sRLS clinically, neuroanatomically and functionally.Consecutive patients hospitalized in the Stroke Unit of the University Hospital of Strasbourg were assessed clinically and electrophysiologically for sRLS characteristics. They underwent brain magnetic resonance imaging for the neuroanatomical study of involved structures, and received functional evaluations withSixteen patients with sRLS, eight women and eight men, aged 41-81 years, were included. The clinical characteristics of sRLS and idiopathic RLS were similar. Most patients presented with bilateral and symmetric de novo RLS. Eight patients had infarction in the lenticulostriate area (middle cerebral artery and internal carotid arteria). The body of the caudate nucleus was most commonly affected. Seven patients had sRLS secondary to ventral brainstem infarction (perforating branches of the basilar arteria) affecting the pons in six patients and the medulla oblongata in one patient. Both the corticospinal tract and the cortico-pontocerebellar fibres were lesioned in all patients with brainstem stroke. One patient had infarction in the left posterior cerebellar vermis and occipital area (posterior cerebral artery and superior cerebellar artery). Isotopic explorations showed a significantly increased dopaminergic tone in the striatum ipsilateral to lenticulostriate infarction. Dopamine fixation was normal in patients with stroke outside of the lenticulostriate area.Clinicians should be aware of the characteristics of sRLS for the appropriate diagnosis and treatment of this condition.

Aim of study. Botulinum neurotoxin type A (BoNT/A) injections are the established treatment in cervical dystonia (CD). But clinical practice regarding the choice of muscles into which injections are made varies between centres. Until now, there have been no dose-per-muscle recommendations based on ‘searching the dose’ clinical trial data. Clinical rationale for study. We therefore examined the dosages under real world conditions at seven international movement disorders centres, using an identical clinical approach. Results. We examined 305 patients with CD (55.6 ± 13.2 years, 204 female). The most commonly injected muscles were the splenius capitis (84.9%), sternocleidomastoid (80.3%), trapezius (59.7%), levator scapulae (49.8%), semispinalis capitis (39%), and obliquus capitis inferior (36.7%). The mean total dose per treatment session with aboBoNT/A was 652.5 (SD = 285.5), with onaBoNT/A it was 159.5 (SD = 62.4), and with incoBoNT/A it was 173.4 (SD = 99.2) units. The doses injected into each muscle in the ona- or incoBoNT/A groups were between 19.7 and 48.2 units, with the highest dose for the splenius capitis with 49.2 ± 26.0 units. The doses in the aboBoNT/A group were between 69.6 and 146.4 units, and the highest dose being injected into the splenius capitis (139.6 ± 80.7 units). Conclusions and clinical implications. In clinical trials the doses per muscle are based on an arbitrary decision. In our study, the doses were lower than in other studies, which may be due to the number of muscles per session, the use of ultrasound guidance (and therefore more precise injections), as well as the use of the Col-Cap concept. Our results exemplify everyday practice, and may help as the basis for recommendations and further investigations.

Botulinum toxin is nowadays approved as an effective medication for various neurological disorders. The extreme toxicity of this toxin-inducing botulism, a severe lethal muscle-paralyzing illness, has been well known since the seminal works of the end of the 19th century. Because of this toxicity, botulinum toxin was one of the first agents to be considered for use as a biological weapon. The Second World War was a crucial period for the first attempts to weaponize this toxin even if many unknown factors about botulinum toxin still existed at the outbreak of the war. Using documents from the British National Archives and other published sources, we discuss the main points of the attempts to weaponize this toxin in German and Allied armies. During WW2, Allied intelligence services regularly reported a major German threat related to the potential use of botulinum toxin as a biological weapon, especially during the preparation of Operation Overlord, the Allied invasion to liberate Europe. All these reports would ultimately prove to be inaccurate: botulinum toxin was not part of the German military arsenal even if some German scientists tried to use the results of the French pre-war military research. Misinformation spread by intelligence services stimulated military research at Porton Down facilities in England and at Camp Detrick in the USA. These studies led to a succession of failures and myths about the weaponization of botulinum toxin. Nevertheless, major progress (purification, toxoid) arose from the military research, providing useful data for the first steps of the therapeutic use of botulinum toxin in the post-war years.

We describe a rare midbrain stroke presenting with predominantly sensory symptoms. A 71-year-old woman was hospitalized due to the recurrence of faciobrachial sensory loss. Magnetic resonance imaging showed an infarct involving the right side of the middle portion of midbrain at the level of the inferior colliculus . In our case we tried to make some clinico-anatomical correlations. The main anatomical structures involved were the medial lemniscal tract, the ventral part of the spinothalamic tract and the trigeminothalamic tract. The location of the stroke would suggest there are overlaps between arterial territories of the midbrain. Clinicians should look for midbrain infarcts in cases of pure sensory stroke.

The classification of abnormal posture and the assessment of the affected muscles in cervical dystonia (CD) have changed in recent years. To determine the frequency of injected muscles, we studied 306 patients with CD. The mean age was 55.5 ± 13.1 years (range 21-90), 67% were female. Splenius capitis was the most commonly injected muscle (83%), followed by sternocleidomastoid (79.1%), and trapezius muscles (58.5%). The three next most common were the levator scapulae, semispinalis capitis, and obliquus capitis inferior muscles. The study shows that the most commonly injected muscles have remained unchanged over the past few decades, although the concept has changed. However, several new muscles have been added that were previously never, or hardly ever, considered.

Background: Tremor is an important phenotypic feature of dystonia. Using the new concept (Col-Cap) of classification we examined the frequency of tremor in cervical dystonia (CD) patients, their main subtypes and muscles injected. Methods: In this large study conducted at multiple movement disorder centres in Europe and India, between January and June 2019, we examined 293 patients with idiopathic CD who were all treated with botulinum toxin (BTX). Results: The dystonic head tremor (DHT+) was present in 57.6 % of CD patients and they had a significantly longer duration of symptoms than patients without head tremor (DHT–). In DHT+ patients torticaput was the most common subtype and the majority (63.3%) had one or two subtypes only. There was no significant difference between the number of unilateral injections for any of the muscles in the DHT+ and DHT– groups, while the number of patients receiving bilateral injections in splenius capitis (78 vs 25; p = 0.00001), sternocleidomastoid (31 vs 6; p = 0.0005), trapezius (28 vs 9; p = 0.01), and obliquus capitis inferior (15 vs 2; p = 0.008) were significantly more in the DHT+ group. The mean doses of all three types of BTX/A were not significantly different between the two groups. Conclusions: The frequency of head tremor was 57.6% in our CD patients and torticaput was the most common dystonic subtype associated with tremor. Simple forms of CD seemed more likely associated with head tremor, than complex forms of CD. Most of the DHT+ patients received bilateral injections. The use of ‘Col-Cap’ classification was helpful in the identification of muscles likely to be involved in tremor in CD patients.

Una lesion del sistema nervioso periferico, en particular en los miembros inferiores, puede afectar a los pies y, de un modo mas general, a la marcha. El electroneuromiograma (ENMG) es la prueba complementaria principal para la exploracion del sistema nervioso periferico. Algunos conocimientos anatomicos y fisiologicos son indispensables para interpretar los resultados y las conclusiones de esta prueba. Un ENMG raramente esta contraindicado, y en algunos casos no esta indicado. Si se trata de una lesion del sistema nervioso periferico, la exploracion fisica permite formular una hipotesis sobre el mecanismo lesional, orientando la investigacion etiologica y la conducta terapeutica inicial. El ENMG, como complemento de la exploracion fisica, es util para confirmar el origen periferico y precisar el mecanismo y el sitio lesional, asi como la gravedad de la lesion, de la que depende el pronostico de recuperacion. En este articulo, los principales troncos nerviosos del miembro inferior se describen en sus planos anatomico y funcional. Se detallaran los sitios lesionales mas frecuentes, asi como las manifestaciones clinicas y la exploracion ENMG especifica de estos troncos nerviosos.

Objective To investigate systematically the presence of the Babinski sign in paintings of the Christ Child by the greatest painters of the Renaissance. Design Observational analysis. Setting Large collection of paintings depicting the Christ Child from Flemish, Rhenish, and Italian schools between 1400 and 1550 CE, searched using published catalogues and Google. Study sample 302 Renaissance paintings (by 19 painters) depicting the Christ Child. Main outcome measure Babinski sign, defined as a hallux extension with an amplitude greater than 30°. The presence of foot sole stimulation was also noted. Results An unquestionable upgoing toe was apparent in 90 (30%) of the 302 paintings. The Babinski sign was present in more than 60% of Christ Child paintings by Rogier van der Weyden, Hans Memling, Martin Schongauer, and Matthias Grünewald. A bilateral Babinski sign was observed in three paintings. Stimulation of the sole was noted in 48/90 (53%) paintings and was always present in paintings by Andrea del Verrocchio, Leonardo da Vinci, and Giorgione. No association existed between the presence of the Babinski sign and the period during which the painter was active. Conclusions Four main factors were noted in relation to the representation of the Babinski sign in paintings of the Christ Child: the physiological toe phenomenon in infants, the representation of the nudity of the Christ by painters during the 15th century to demonstrate the incarnation, Renaissance painters’ need for precise observation of anatomy, and the desire of some Rhenish and Flemish painters to depict very realistic details. Italian Renaissance painters, whether Mannerist or not, tended to idealise the beauty of human body, and they often did not reproduce the Babinski sign.

At first glance, cervical dystonia might be an illustration of the well-known proposition "function follows form". Nevertheless, cervical dystonia is a highly non-physiological condition, which cannot be reproduced by healthy subjects and does not respond to the usual physiological rules. "Dysfunction follows form" might be the most accurate aphorism to define cervical dystonia. Taking into account this situation and recent insights, the anatomic approach needs to be adapted to allow a better understanding of semiology and to improve botulinum toxin therapy. In this review dealing with a new approach to cervical dystonia, we develop some practical anatomical concepts concerning the head and neck complex. Knowledge of cervical spine and muscular dysfunctions in cervical dystonia is an essential stage in treating cervical dystonia patients with botulinum toxin.

Objective The pathophysiology of restless legs syndrome (RLS) involves a dopaminergic dysregulation that remains poorly understood, with controversial data from the literature. Stroke-related RLS is a rare condition that involves primarily the basal ganglia, the paramedian pons, and the thalamus. Given these elements, we studied dopaminergic metabolism in patients with RLS secondary to lenticulostriate infarction using structural and nuclear imaging in the striatum ipsilateral to the infarction area, as compared to the contralateral side. We hypothesized that dopaminergic metabolism would be impaired in the striatum ipsilateral to stroke. Methods In this observational case-control study, we aimed to prospectively include patients with RLS secondary to lenticulo-striate infarction, for analyses of dopamine dysfunction ipsilateral to stroke as compared to the contralateral striatum and to a control population. Four patients fulfilled inclusion criteria with either de novo RLS or major exacerbation of RLS existing prior to stroke, and all four patients were included. Structural imaging was performed using brain magnetic resonance imaging, and the stroke-induced metabolic modifications were assessed by 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET). Dopamine reuptake via DAT was explored using 123 I-FP-CIT SPECT. PET with 18 F-FDOPA was used to evaluate the functional integrity of the presynaptic dopaminergic synthesis. Results The only structure damaged in all patients was the body of the caudate nucleus, right-sided for three and left-sided for one, as illustrated by magnetic resonance imaging. 18 F-FDG PET showed a hypometabolism in the infarcted area, the ipsilateral thalamus, and the contralateral cerebellum. All patients displayed, in the ipsilateral putamen, increased dopaminergic tone. Conclusion The present findings suggest that increased dopaminergic tone in the striatum may participate in the pathogenesis of RLS. These observations should encourage further research on RLS symptomatic with well-defined lesions as a promising way to further improve our understanding of its pathophysiology.

The issue of First World War shell shock has been documented mainly from a medical perspective. Many medical texts dealing with war psychoneuroses and their aggressive treatments, such as electrotherapy, were published during the war. Accounts from shell-shocked soldiers are rare. Nevertheless, shell shock was described from a non-medical point of view by a few writers who had undergone or witnessed this pathology. Their texts deal mainly with the psychiatric forms, the most striking ones, but also with the more common concepts of commotion, emotion and pathological fear. The French philosopher Émile Chartier (1868-1951), alias Alain, described the commotional syndrome from which he suffered. The German writer Ernst Jünger (1895-1998), a brave officer and an example for his men, reported his emotional shock. Some psychiatric forms of shell shock are present in the work of the pacifist writer Jean Giono (1895-1970), the naturalist Maurice Genevoix (1890-1980), who suffered himself from a section of the left median and ulnar nerves, or the British poet Siegfried Sassoon (1886-1967). War hysteria and pathological fear have been described, on several occasions, by Blaise Cendrars (1887-1961) or the German writer Erich Maria Remarque (1898-1970). Electrotherapy has been scarcely reported except by Louis-Ferdinand Céline (1894-1961).

Many artists were involved in the First World War. Some of them were mobilized, like millions of soldiers, others enlisted to fight on the battlefield. The stories of writers who returned neurologically wounded from the war, such as Guillaume Apollinaire (1880-1918) or Blaise Cendrars (1887-1961), are well-known. The cases of painters and sculptors who suffered from First World War neurological wounds are scarce. Nevertheless, their injuries led to intense modifications of artistic practice. We detail four examples of artists whose creative mind was impacted by their First World War neurological wounds or diseases. The painter Jean-Julien Lemordant (1878-1968), who suffered from blindness after his injury, stopped his artistic work and became an icon of Franco-American friendship. The sculptor Maurice Prost (1894-1967), suffering from a neuroma due to the loss of his arm, built a special device to continue his work as a wildlife artist. The painter Georges Braque (1882-1963) was trepanned but carried on with his cubist work without ever mentioning the conflict. Conversely, the painter Fernand Léger (1881-1955), who suffered from a war neurosis, produced a significant war testimony through drawings and letters.

The writer Louis Ferdinand Céline (1894-1961) developed a personal style which changed twentieth century French literature. As an enlisted soldier in 1912, he was involved in the Great War and his right arm was severely wounded. After the war, he became a medical doctor and a writer who published his first novel, Voyage au bout de la nuit (Journey to the End of the Night), in 1932. In the middle of the 1930s, he began to write anti-Semitic and racist pamphlets and turned to a collaborationist stance with Nazi Germany. After the Second World War, he was declared a national disgrace in France and fled to Denmark. In 1951, he was granted amnesty and went back to France, where he regained fame with his last three novels. Céline was a First World War neurologically wounded soldier who received a severe injury in the right arm leading to a radial nerve paralysis. Furthermore, in his texts and letters, he complained of many symptoms that he considered to be related to the First World War. In reality, to build a heroic image of himself, Céline rewrote his personal First World War history, in particular his war wounds. The aim of this reconstruction was to help him achieve literary fame. At the end of the Second World War, he also used this rewriting to organise his defence when he was accused and tried for collaborationism. Using medical and military archives, Céline's First World War medical mythology is reviewed to distinguish facts from fiction concerning his wound and other war neurological disturbances. We present the history of his radial nerve lesion and surgery, and confirm that Céline was never trepanned. Two other controversial neurological points, his left ear disease and his possible shell shock, are also discussed.

The purpose of our study was to determine the main anatomical features of the calcarine sulcus using a 3-T MRI. Fifty human brains have been explored using an MRI 3-T in Doctors Center in Beirut (Lebanon). The calcarine sulcus was identified in 100% of cases. In most cases, it had a continuous aspect with several peaks. In all our specimens, the calcarine sulcus crosses the parieto-occipital fissure. The majority of their collateral branches and their connections with other sulci were located at the level of the calcarine sulcus properly. In the majority of specimens, the deepest part of the anterior calcarine sulcus forms a protrusion in the occipital horn of the lateral ventricle called calcar avis. Our study emphasizes the fact that the course patterns of the calcarine sulcus are highly variable. The description of the main anatomical features of the calcarine sulcus obtained from our study can be used as a reference for fMRI exploration and is useful for brain surgery.

Many artists were involved in the First World War. Some of them were mobilized, like millions of soldiers, others enlisted to fight on the battlefield. The stories of writers who returned neurologically wounded from the war, such as Guillaume Apollinaire (1880-1918) or Blaise Cendrars (1887-1961), are well-known. The cases of painters and sculptors who suffered from First World War neurological wounds are scarce. Nevertheless, their injuries led to intense modifications of artistic practice. We detail four examples of artists whose creative mind was impacted by their First World War neurological wounds or diseases. The painter Jean-Julien Lemordant (1878-1968), who suffered from blindness after his injury, stopped his artistic work and became an icon of Franco-American friendship. The sculptor Maurice Prost (1894-1967), suffering from a neuroma due to the loss of his arm, built a special device to continue his work as a wildlife artist. The painter Georges Braque (1882-1963) was trepanned but carried on with his cubist work without ever mentioning the conflict. Conversely, the painter Fernand Leger (1881-1955), who suffered from a war neurosis, produced a significant war testimony through drawings and letters.

This chapter is aimed at highlighting the recent findings concerning physiopathology, diagnosis, and management of conversion, factitious disorder, and malingering. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist's consultation. The first challenge is to detect them, and recent studies have confirmed the importance of "positive" clinical bedside signs based on incoherence and discordance, such as the Hoover's sign for the diagnosis of conversion disorder. Functional neuroimaging has allowed a better understanding of the pathophysiology, and highlighted abnormal cerebral activation patterns in conversion disorder in relation to motor, emotional, and limbic networks, different from feigners. This supports the theory evoked by Charcot of a "psychodynamic lesion," which is also reflected by the new term introduced in the DSM-5: functional neurological disorder. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.

The writer Louis Ferdinand Celine (1894-1961) developed a personal style which changed twentieth century French literature. As an enlisted soldier in 1912, he was involved in the Great War and his right arm was severely wounded. After the war, he became a medical doctor and a writer who published his first novel, Voyage au bout de la nuit (Journey to the End of the Night), in 1932. In the middle of the 1930s, he began to write anti-Semitic and racist pamphlets and turned to a collaborationist stance with Nazi Germany. After the Second World War, he was declared a national disgrace in France and fled to Denmark. In 1951, he was granted amnesty and went back to France, where he regained fame with his last three novels. Celine was a First World War neurologically wounded soldier who received a severe injury in the right arm leading to a radial nerve paralysis. Furthermore, in his texts and letters, he complained of many symptoms that he considered to be related to the First World War. In reality, to build a heroic image of himself, Celine rewrote his personal First World War history, in particular his war wounds. The aim of this reconstruction was to help him achieve literary fame. At the end of the Second World War, he also used this rewriting to organise his defence when he was accused and tried for collaborationism. Using medical and military archives, Celine's First World War medical mythology is reviewed to distinguish facts from fiction concerning his wound and other war neurological disturbances. We present the history of his radial nerve lesion and surgery, and confirm that Celine was never trepanned. Two other controversial neurological points, his left ear disease and his possible shell shock, are also discussed.

The issue of First World War shell shock has been documented mainly from a medical perspective. Many medical texts dealing with war psychoneuroses and their aggressive treatments, such as electrotherapy, were published during the war. Accounts from shell-shocked soldiers are rare. Nevertheless, shell shock was described from a non-medical point of view by a few writers who had undergone or witnessed this pathology. Their texts deal mainly with the psychiatric forms, the most striking ones, but also with the more common concepts of commotion, emotion and pathological fear. The French philosopher Emile Chartier (1868-1951), alias Alain, described the commotional syndrome from which he suffered. The German writer Ernst Junger (1895-1998), a brave officer and an example for his men, reported his emotional shock. Some psychiatric forms of shell shock are present in the work of the pacifist writer Jean Giono (1895-1970), the naturalist Maurice Genevoix (1890-1980), who suffered himself from a section of the left median and ulnar nerves, or the British poet Siegfried Sassoon (1886-1967). War hysteria and pathological fear have been described, on several occasions, by Blaise Cendrars (1887-1961) or the German writer Erich Maria Remarque (1898-1970). Electrotherapy has been scarcely reported except by Louis-Ferdinand Celine (1894-1961).

Edouard Manet (1832-1883) is considered the "father" of impressionism and even of twentieth century modern art. Manet's genius involved getting away from the classical narrative or historical topics and replacing them by the banality of daily life. Technically, he erased volumes into flat two-dimensional coloured planes, and distorted conventional perspective with often gross brushstrokes intentionally giving an "unfinished" aspect to the work. It is little known that Manet had a very painful second part of his life, due to excruciating limb and chest pains, which developed in parallel with proprioceptive ataxia and gait imbalance. Manet always remained discreet about his private life, and we mainly know that his future wife was his family piano teacher, with whom he had a liaison at the age of 17 years. Later, the great but platonic passion of his life was the painter Berthe Morisot (1841-1895), who married Manet's brother Eugene. In fact, we do not know whether he had a mistress at all, although he had several elegant "flirts" in the mundane and artistic milieu. Thus, while Manet's progressive painful ataxia from the age 40 years yields little doubt on its tabetic origin, how he contracted syphilis at least 15-20 years before will probably remain a mystery. It is fascinating that Manet's daily struggle against pain and poor coordination may have led his art to become one of the most significant of modern times, opening the way to twentieth century avant-gardes, along with another victim of syphilis, Paul Gauguin (1848-1903). Manet never showed any sign of general paresis, and like his contemporary, the writer Alphonse Daudet, his clinical picture remained dominated by paroxysmal pain and walking impairment. Difficult hand co-ordination made him quit watercolour painting, and during the last 2 years of his life he had to focus on small format oil works, the subject of which was nearly limited to modest bunches of fresh flowers, now often considered to be his maturity masterpieces. Having become bedridden, he had to be amputated of one leg, which was developing gangrene, probably associated with ergot overuse. While he died shortly thereafter, we have some witness anecdotes suggesting that he experienced a phantom limb: when Claude Monet (1840-1926) visited him and sat down on his bed, Manet violently shouted that he was sitting on his (absent) leg, which provoked terrible pains. With its facts and mysteries, the subtle interaction between Manet's illness and his work output remains one of the most intriguing stories in the neurology of art.

The famous poet Arthur Rimbaud (1854-1891) stopped writing poetry at 21 years and subsequently had a rather adventurous life mainly in the Arabic peninsula and Ethiopia. He died at 37 years, only a few months after the amputation of his right lower limb due to a developing tumor in the knee, which probably was an osteosarcoma in the lower third of the femur. His letters to his sister Isabelle suggest that he suffered from severe stump pain rather than phantom limb, but since he lived only shortly after surgery (he developed extensive carcinomatosis), one does not know whether a full phantom would have developed and how this would have affected his subsequent life.

The primary purpose of this study was to define the size of the trapezium bone through measurements on cadaver specimens and CT scans of living subjects. The secondary purpose of this study was to determine if any correlation existed between the size of the trapezium and local anatomical parameters. The radio-ulnar length (L), dorsopalmar width (l) and height (h) of the distal surface of the trapezium were measured by two independent observers on 20 cadaver specimens. The same measurements were carried out by two other observers on anonymized CT scans from 18 patients. The inter- and intra-observer agreement was determined using the intraclass correlation coefficient. In the cadavers, the mean length, width and height of the trapezium were 22.8, 15.5 and 15.2 mm, respectively. On the CT scans, these same dimensions were 19.2, 11.4 and 11.6 mm. Inter-observer agreement was statistically significant in both parts of the study. The dimensions of the trapezium bone were about 3.33 mm larger in cadavers than on CT scans. These differences can be explained partially by a systematic under-sizing error on the CT scans and the fact that the cartilage layer cannot be directly visualized. This study was able to define the dimensions of the trapezium bone. It may be possible to predict the trapezium height from the length of the forearm or the width of the radial epiphysis. Our data can be used to adjust the size of trapezium implants to the dimensions of the patient’s bone.

Camptocormia is defined as an involuntary flexion of the thoracolumbar spine, without fixed kyphosis, which increases during walking and standing, and abates in the supine position. First described during World War 1 in soldiers suffering from war psychoneuroses, camptocormia has progressively come to refer to any cause of trunk forward-flexed posture during standing and ambulation. It is now admitted that camptocormia should be considered as a syndrome related to many etiologies. In this chapter, we present the historical aspects of the syndrome and its main etiologies. We highlight camptocormia in Parkinson disease and its relationships with Pisa syndrome.

Since its initial description in 1851, Munchausen syndrome has been widely used interchangeably with factitious disorder. Nevertheless, this syndrome is only one form of factitious disorder that is both severe and chronic. The syndrome was named after Karl Friedrich Hieronymus, Baron von Münchhausen (1720-1797), a German nobleman who became famous as a narrator of false and exaggerated exploits. His name was progressively corrupted to Munchausen. Factitious disorders and Munchausen syndrome remain a great diagnosis challenge for physicians. All medical specialities are concerned by these disorders. The diagnosis process involves a first step to exclude an unusual presentation of a common medical condition. The second step consists of excluding somatoform disorders and malingering. Unfortunately, the boundaries between factitious disorder, somatization, and malingering are often unclear. In 1977, the term "Munchausen's syndrome by proxy" was coined to define a situation where a person produces false symptoms in another one, especially a child. This term was extended to similar interactions between human and pets. Because varied conditions have been included in the definition of this syndrome, there is ongoing debate about alternative names.

Body representation disorders continue to be mysterious and involve the anatomical substrate that underlies the mental representation of the body. These disorders sit on the boundaries of neurological and psychiatric diseases. We present the main characteristics of 3 examples of body representation disorders: phantom sensations, supernumerary phantom limb, and apotemnophilia. The dysfunction of anatomical circuits that regulate body representation can sometimes have paradoxical features. In the case of phantom sensations, the patient feels the painful subjective sensation of the existence of the lost part of the body after amputation, surgery or trauma. In case of apotemnophilia, now named body integrity identity disorder, the subject wishes for the disappearance of the existing and normal limb, which can occasionally lead to self-amputation. More rarely, a brain-damaged patient with 4 existing limbs can report the existence of a supernumerary phantom limb.

Camptocormia is defined as an involuntary flexion of the thoracolumbar spine, without fixed kyphosis, which increases during walking and standing, and abates in the supine position. First described during World War 1 in soldiers suffering from war psychoneuroses, camptocormia has progressively come to refer to any cause of trunk forward-flexed posture during standing and ambulation. It is now admitted that camptocormia should be considered as a syndrome related to many etiologies. In this chapter, we present the historical aspects of the syndrome and its main etiologies. We highlight camptocormia in Parkinson disease and its relationships with Pisa syndrome.

Since its initial description in 1851, Munchausen syndrome has been widely used interchangeably with factitious disorder. Nevertheless, this syndrome is only one form of factitious disorder that is both severe and chronic. The syndrome was named after Karl Friedrich Hieronymus, Baron von Münchhausen (1720-1797), a German nobleman who became famous as a narrator of false and exaggerated exploits. His name was progressively corrupted to Munchausen. Factitious disorders and Munchausen syndrome remain a great diagnosis challenge for physicians. All medical specialities are concerned by these disorders. The diagnosis process involves a first step to exclude an unusual presentation of a common medical condition. The second step consists of excluding somatoform disorders and malingering. Unfortunately, the boundaries between factitious disorder, somatization, and malingering are often unclear. In 1977, the term "Munchausen's syndrome by proxy" was coined to define a situation where a person produces false symptoms in another one, especially a child. This term was extended to similar interactions between human and pets. Because varied conditions have been included in the definition of this syndrome, there is ongoing debate about alternative names.