Neuropathology

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Neuropathology

 

a branch of neurology in the USSR that studies the etiology, pathogenesis, diagnosis, treatment, and prophylaxis of nervous diseases. In the USA and in many other countries, the term “neuropathology” has the narrower meaning of a nervous system pathomorphism. The study of nervous system diseases also comes under the realm of neurosurgery and neuropsychiatry.

Some ancient Greek and Egyptian sources contain such information on diseases of the nervous system as descriptions of epilepsy and of external symptoms in paralytic patients. Ancient Chinese medical treatises set forth the methodology of acupuncture for application to many disorders, including headaches and backaches. The bases for diagnosing diseases of the nervous system were set by Hippocrates, Galen, Erasistratos of Chios, and Aulus Cornelius Celsus. Subsequent progress in the early development of the science of neuropathology is associated with Rhazes and Ibn Sina (Avicenna). In the 19th century many physicians, including the French scientists J. M. Charcot and P. Marie and the British physician J. Parkinson, described various diseases of the nervous system.

The establishment of neuropathology as an independent scientific discipline in Russia is associated with A. Ia. Kozhevnikov, who headed the first subdepartment of nervous diseases at Moscow University in 1869 and created an important school of neuropathologists and psychiatrists. V. K. Rot, a student of Kozhevnikov, investigated muscular atrophy. G. I. Rossolimo, another student of Kozhevnikov, described a pathologic reflex that occurs when there is an organic lesion of the central nervous system; he also introduced psychological methodology into neurology. L. O. Darkshevich, who established the location and significance of certain nuclei in the brainstem, was also a student of Kozhevnikov. A representative of the St. Petersburg school, L. V. Blumenau, more accurately defined the course of many conduction pathsways in the brain. V. M. Bekhterev described a number of neurological diseases and symptoms. The research of the following scientists played an important role in the development of the science of neuropathology in the USSR: M. I. Astvatsaturov, N. K. Bogolepov, N. I. Grashchenkov, A. M. Grinshtein, S. N. Davidenkov, N. V. Konovalov, N. I. Zakharchenko, M. B. Krol’, B. N. Man’kovskii, L. S. Minor, A. V. Razdol’skii, P. M. Saradzhishvili, E. K. Sepp, and E. V. Shmidt.

In neuropathology the patient is examined by a method that is peculiar to this branch of medicine: his neurological status is carefully studied, which helps to determine the character of both organic and functional diseases, and the focus of the disease is precisely located (niveau diagnosis). Angiography and rheography help to expose pathology in blood circulation, and intracranial foci of disease are discovered through echoencephalography. Morbid processes in the neuromuscular apparatus are studied by means of electromyography. Electroencephalography, roentgenography, and examination of the organ of vision have broad applications in neuropathology.

Disturbances in brain circulation, especially cerebrovascular crises and insults, are the most important topics of neuropathology. Cardiac pathology and hypertensive disease play a role in such disturbances, as do atherosclerosis of the blood vessels of the brain and anomalies in the large vessels of the neck that supply the brain with blood. Circulatory disturbances in the spinal cord (spinal insults) have also received considerable attention in neuropathology.

Successful study of infectious diseases of the nervous system has led to elucidation of the role of neurotropic viruses and the allergic response in the development of neural infections. Another infectious disease described in neuropathology is a form of tick encephalitis that is most often observed in the taiga regions of Siberia (Russian spring-summer encephalitis). Owing to the increased occurrence of traumatism in modern societies, craniocerebral injury and its remote sequelae (traumatic epilepsy, for example) have been intensively studied; in this connection, it is also especially important to investigate traumas of the spinal cord and peripheral nerves. Study of the autonomic nervous system has made it possible to refine the definition of the role of central regulatory mechanisms in pathology (the hypothalamus has received special attention). The role that pathological changes in the spine play in the origin and early development of diseases of the spinal cord and spinal nerve roots has been well established. Osteochondrosis—the deposition of salts accompanied by changes in ligamentous articular structures—is one such pathological change that frequently impairs a person’s ability to work.

An independent branch of neuropathology is pediatric neuropathology, whose founders in Russia were Rot, V. A. Muratov, and Rossolimo. An important division of pediatric neuropathology is the neuropathology of early childhood; the primary concern of this discipline is the etiology, pathogenesis, treatment, and prevention of birth traumas in newborn infants. Neurogerontology is a new division of neuropathology that studies the functions and diseases of the nervous system in the aged. Recently, the study of hereditary diseases of the nervous system has achieved independent status within the field of neuropathology. These diseases are characterized by a progressive course and are accompanied by a disturbance of nervous and mental functions, paralyses, and disturbances of motor coordination.

In recent times, the possibility of successfully treating diseases of the nervous system has broadened. Effective medicinal treatment employs such agents as neuroleptics, ganglionic blocks, and tranquilizers. Intensive therapeutic methods, including reanimation, have been developed in treating vascular afflictions of the brain. Neurosurgical methods and X-ray therapy are now used to treat intracranial hemorrhages and brain tumors. Progress in the treatment of neuromuscular diseases includes the development of hyperbaric oxygen treatment and electrostimulation techniques. Rehabilitative therapy is used to ensure compensation for disturbed functions. Epidemics of paralytic poliomyelitis have been eliminated by means of vaccines.

The establishment of special sanatoriums and of psychoneurological dispensaries and offices in polyclinics is evidence of the emphasis on prevention in Soviet medicine. Neuropathologists receive their training in subdepartments of neuropathology at institutions of higher medical learning and at advanced training institutes for physicians. (For information on scientific institutions and periodicals and for references, see.)

L. O. BADALIAN

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