The metaphysical art of Giorgio de Chirico. Migraine or epilepsy?

It has been suggested that the great Italian painter Giorgio de Chirico (1888-1978), who developed the unique style of 'metaphysical art', suffered from migraine and used some of his morbid manifestations as a source of inspiration for his paintings. Yet, whereas many of the symptoms that de Chirico described are rare in migraine, they are frequently encountered in patients with temporal lobe epilepsy. Here we rediscuss de Chirico's symptoms critically and suggest that, if his symptoms were of neurological origin, they rather relate to temporal lobe epilepsy than migraine.     

Friederich Nietzsche and the seduction of Occam’s razor

Friedrich Nietzsche developed dementia at the age of 44 years. It is generally assumed that the cause of his dementia was neurosyphilis or general pareisis of the insane (GPI). Others have proposed frontal-based meningioma as the underlying cause. We have reviewed Nietzsche’s medical history and evaluated the evidence from the medical examinations he underwent by various physicians. We have viewed the possible diagnosis of GPI or meningioma in light of present neuro-ophthalmic understanding and found that Nietzsche did not have the neurological or neuro-ophthalmic symptoms consistent with a diagnosis of GPI. The anisocoria which was assumed to be Argyll Robertson pupil was present since he was six years of age. He did not have tongue tremor, lacked progressive motor features and lived at least 12 years following the onset of his neurological signs. Furthermore, the headaches that have been attributed to a frontal-based tumour were present since childhood and the pupil abnormality that has been interpreted as an “afferent pupillary defect” had the characteristics of an abnormality of the efferent pupillary innervation. None of the medical records or photographs suggest there was any ocular misalignment. We concluded that neither diagnosis of GPI nor frontal-based meningioma is convincing. It is likely that Nietzsche suffered from migraines, his blindness in his right eye was a consequence of high progressive myopia associated with retinal degeneration, his anisocoria explained by unilateral tonic pupil, and his dementia by an underlying psychiatric disease.     

The neuropsychiatric ailment of Vincent Van Gogh

Vincent Van Gogh is one of the most celebrated creative artists of all time. All his life, he was afflicted by some kind of neurological or psychiatric disorder, which remains a mystery even today. Many historians and his personal physicians believe that he suffered from epilepsy while others felt that he was affected by Ménière''s disease. Features such as hypergraphia, atypical sexuality, and viscosity of thinking suggest the possibility of Gastaut-Geschwind phenomenon, a known complication of complex partial seizure. On the contrary, some historians feel that he was forced to sever his right ear in order to get relief from troublesome tinnitus, a complication of Ménière''s disease. He was addicted to the liquor absinthe, which is known to lead to xanthopsia, and many authorities argue that this was the reason for his penchant for the deep and bright yellow color in many of his paintings. Others have suggested the possibility of bipolar disorder, sunstroke, acute intermittent porphyria, and digitalis toxicity as well.     

Pictorial creations of a painter presenting with left-sided neglect

We report the pictorial evolution of a well-known French painter, before and after a left hemiplegia. Before the stroke he was famous not only for his drawings but also for his paintings. The evolution comprised 3 periods. Just after the stroke, the painter presented with severe exacerbation of a chronic depression. The second period was characterized by a rich pictorial production, with an excellent spatial organization of drawings; the style remained well recognizable and the favourite topics were unchanged: streets' scenes, country women, bunches of flowers. Shapes, drawings and volumes were well preserved. The neglect concerned not only the left hemispace but also the "microspaces" on the left side of which the painter's gaze attention had been fixed. Analysis of the production for this period supports the hypothesis according to which the neglect would be explained by a selective defect in automatic orientation of the attention on the left side. In the last period the aggravation appeared to bear more on the instrumental processes than on the esthetic capacities.     

Recurrent depressive disorder in Caspar David Friedrich. A pathographical approach with operationalized diagnosis

Caspar David Friedrich (1774 - 1840) is one of the most important German Romantic painters. In his paintings, he prototypically represents the melancholy, which has been mentioned by his contemporaries and later biographers. Art scientists have also referred to his melancholy for the interpretation of his work. From a medical point of view, there are only two pathographies which remain inconclusive. Having applied diagnostic criteria for psychiatric disorders to his letters and publications, to statements of his contemporaries and to his art, we propose that he had suffered from a recurrent major depression which occurred in 1799 for the first time. At least three depressive episodes followed before he was struck by a stroke in 1835. There are epidemiological, psychodynamic and personality-typological reasons supporting our diagnostic assumption. The course of his depression corresponds to phases of reduced creativity, to the chosen techniques and motives. Finally we discuss the implications of our approach for the pathographical method in general.     

The consequences of stroke for the artist Lovis Corinth

The artist Lovis Corinth suffered a right-hemispheric stroke at the age of 53 years but only died 14 years later. The huge amount of work he produced after this life threatening disease allows detailed analysis of his post-stroke artwork in comparison to pre-stroke. When performing this analysis as a neurologist, an enormous diversity of subtle stroke sequelae can be discovered that are mostly explained by left-sided hemi-neglect. These findings clearly go far beyond pure psychological processes. Moreover, Corinth is a motivating example for disabled patients because he was able to produce great artwork after his stroke. He was struggling against a motor disability admittedly not severely affecting his artistic production, but also against severe neuropsychological deficits that did have clear consequences. Lovis Corinth left us the credo "True art means to use unreality". Taken together with the often cited phrase "Drawing means to leave out (details)", a clear-cut interpretation for neurologists can be derived from the understanding of right-hemisphere lesions and subsequent left-sided neglect.     

Straight-ahead pointing correlates with long-line bisection in neglect patients

The spatial bias of neglect patients has been assumed to result from the alteration of a body-centred representation which underlies actions within personal and extra-personal spaces. This deficit seems to correspond to the ipsilesional deviation of the subjective straight-ahead (SSA), often described in neglect patients. However, several recent studies have failed to show significant correlations between the SSA deviation and performance in standard visuo-spatial tests of neglect. Since methodological choices could explain these negative results, the present study re-investigated the question. SSA, assessed by manual pointing, was anchored by instructions to a precise median body part. A body-centred line bisection task was also carried out, during the same session and in similar experimental conditions. Sixteen right brain-damaged patients with (n=8) or without (n=8) neglect, and 8 control subjects free of any neurological problem were included. Taken as a group, the neglect group stood out from the others in both tasks. Moreover, in neglect patients only, SSA position significantly correlated with bisection error for long lines, even if dissociations between SSA shift and bisection error were found in two cases. Results are discussed with regard to the nature of the tasks proposed in the different studies and to methodological aspects that could at least partly explain the aforementioned failures.     

Whipple's disease of the central nervous system

Summary Whipple's disease presenting as a neurological disease without gastrointestinal symptoms is an unusual occurrence. A 40 year old man suffered hypersomnia, memory loss and progressive ophthalmoplegia for 6 months prior to death. The nature of his disease was not established during life. Extensive granulomatous inflammation affecting the hypothalamus, hippocampus and periaqueductal gray matter of the brain was found to represent Whipple's disease by electron microscopy. Characteristic lesions were also present in spleen, mesenteric lymph nodes, small intestine and myocardium. Bacillary bodies and membranous inclusions similar to those seen in visceral lesions of Whipple's disease were present in macrophages. The findings supported the theory of direct involvement of the central nervous system by bacilli rather than a metabolic origin for the lesions.     

Dysfunction of a structurally normal motor pathway in a brain injury patient as revealed by multimodal integrated techniques

We report on a patient with left hemiparesis and peripersonal neglect after post-traumatic left frontal hemorrhage, who underwent fMRI, TMS and TCD to identify the functional abnormalities that account for his neurological symptoms, in the absence of any detectable lesion affecting right motor areas.     

Dysfunction of a Structurally Normal Motor Pathway in a Brain Injury Patient as Revealed by Multimodal Integrated Techniques

We report on a patient with left hemiparesis and peripersonal neglect after post-traumatic left frontal hemorrhage, who underwent fMRI, TMS and TCD to identify the functional abnormalities that account for his neurological symptoms, in the absence of any detectable lesion affecting right motor areas.