Biographies de neurologues
Nouvelle Iconographie de La Salpêtrière
 L'histoire des neurosciences à La Pitié et à La Salpêtrière J Poirier
The history of neurosciences at La Pitié and La Salpêtrière J Poirier 

mise à jour du
25 août 2005
The canadian Medical Ass J
june 1934
XXX; 6
The influence of the diencephalon and hypophysis upon general autonomic function
Wilder Penfield
Penfield W, Jasper H Diencephalic autonomic seizures1954


 Les biographies de neurologues
The diencephalon
The diencephalon (called also interbrain, or tween brain), surrounding as it does the third ventricule and including thalamus, hypothalamus and infudibulum, is a very old portion of the brain, being well developed in the lowest vertebrate forms which possese little or no forebrain. Without daring to stop for a detailed anatomical discussion I may point out only that lying beneath the walls of the third ventricle are supraoptic nuclei and nuclei of the tuber cinereum which seem to be closely associated with the posterior lobe of the pituitary, being connected with each other by afferent and efferent fibres. This complex Beattie has labelled the anterior mechanism. He might perhaps have borrowed from Cushing the term "neurohypophyseal" mechanism. There is some evidence that this anterior group of nuclei may deserve the adjective "para-sympathetic" because of the relationship of the tuberal nuclei to the craniosacral division of the autonomic nervous system with its peripheral control through vagus and pelvic nerves.
The posterior group of nuclei located in the walls of the posterior portion of the third ventricle above the corpora mammillana are said to contain the sympathetic centres. Efferent tracts, composed of short neurones which pass downward through brain stem and cord, are assumed for both anterior and posterior complexes, but in the ease of the posterior group a sympathetic pathway was actually followed by Beattie, Brow and Long' from this region down the posterior longitudinal bundle and cervical cord, through the second, third and fourth thoracic anterior roots to the stellate ganglion and thence to the heart. The afferent tracts so far demonstrated to these centres are chiefly derived from the diencephalon and from the forebrain. It seems somewhat surprising that the afferent pathways should come from "headward" regions. It may be that forebrain and thalamus form stations on the pathway from periphery to hypothalamic centres, but it is also evident that what may be considered afferent impulses reach these centres through the blood stream. For example, if the blood entering the thalamus be raised above the normal temperature there is a response from the nervous mechanism in the vicinity which results in a discharge, chiefly parasympathetic, which lowers the general temperature by sweating, vasodilatation and diminished oxidation.
Attention must be called also to the existence of a portal system of veins which is said to pass upward from both anterior and posterior lobes of the hypophysis through the infundibulum (Popa and Fielding; see also Basir, 1932), where they break up into a secondary distributing net beneath the infundibular recess of the third ventricle. Further, a colloid substance has been described in these veins by Collin," also by Popa and Fielding," and by Cushing.' If this proves to be true much of the hormonal material from the pituitary may act directly upon the nervous system. But Espinasse" has most recently urged that these vessels are arteries, not veins, and fails to find colloid material in them. There is, in any case, a partial drainage into the general circulation by way of the cavernous sinus, which is derived chiefly from the sinusoids in the anterior lobe. Innervation of the posterior lobe is by nerve fibres from supra-optic and tuber nuclei, while the anterior lobe is innervated by fibres derived from the carotid plexus (Dandy).
In January, 1928, I was fortunate enough to have under my care at the Presbyterian Hospital in New York a patient with a small, discrete, encapsulated tumour so placed that it impinged upon the anterior and superior portion of the thalamus of each aide. She was subject to recurring seizures which resembled epileptic attacks, excepting that the manifestations of the attack were confined to the realm of the autonomic nervous system. The case was published under the heading "Diencephalic autonomic Epilepsy".
Now, an epileptic discharge is a gross revelation of the function of an area, somewhat in caricature no doubt, but the true features of function are there to be scanned (Jackson) by him who can read. The epileptic phenomena which I shall recount in order of their habitual appearance may therefore reveal to us the function of this region. We may think of the disturbance spreading downward and backward from the tumour site.
1. Prodromal restlessness and sometimes a desire to void.
2. Sudden intense dilatation of skin of face, arms and breasts. Sudden rise in the blood pressure from 110 up to 200.
3. Lacriniation; diaphoresis; salivation; dilatation (or contraction) of pupils; protrusion of eyes (not invariably present); increase of rate and of pressure of pulse; marked retardation of respiratory rate; elicitability of pilomotor reflex.
4. Disappearance of superficial blush and fall of blood pressure; slowing and weakening of pulse.
5. Hiccups (from 3 to 5 in number).
6. Transient shivering.
During the present year I have had under my care at the Royal Victoria Hospital 3 other patients who showed certain features of autonomic epilepsy. One of these may be mentioned here.
A woman of 29, with a tumour involving the under surface of the left temporal lobe and extending to the midbrain and thalamus. She had had recurring slight attacks consisting of sudden headache, followed by yawning and hiccuping and sometimes associated with patchy erythema in different areas of the body. There was one attack of greater severity, characterized by a rise of blood pressure to 200 over 90, whereas the usual level approximated 100 over 70. With this there was a simultaneous rise of the pulse rate to 120, flushing and appearance of irregular erythema over the chest and thighs, spontaneous appearance of "goose flesh", slowing of the respirations to 4 per minute, salivation, lacrimation, dilatation of the left pupil, and contraction of the right.
This description tallies sufficiently with the first to make it clear that we are not dealing with a discharge of a parasympathetic system alone, as Cushing concludes in reviewing the first ease. It is an explosive, undiscriminating, discharge which betrays the spatial relationships both of parasympathetic and sympathetic function. The dilatation of the peripheral vessels and sweating might be considered as parasympathetic in nature, but the pilomotor response and increased pulse rate, increased blood pressure, and protrusion of the eyes obviously belong in the sphere of the sympathetic. Another instance may be cited.
In the case of a boy of 14 I approached a tumour of the third ventricle through the right lateral ventricle under nupercaine analgesia. Taking hold of the tumour as it presented in the foremen of Monro I moved it within the third ventricle. The patient "hummed" and then vomited in a projectile manner, after which there was generalized shivering, followed by sudden frantic scratching of the inner aspect of the left thigh and there appeared very marked reddening of that skin area. Following this he became disoriented as to place. His temperature rose from 99 at the time of the shivering to 102e an hour and a half later. This boy returned to our clinic last week, nine months after operation, complaining of generalized urticaria. His papilloedema had disappeared and he seemed well in other ways.
In the light of the operative findings and the sudden erythema seen at operation it seems justifiable to suggest that his urticaria is due to some recurrence of the tumour in the wall of the third ventricle.
It is recognized that the urticarias and the general reaction, for example after serum injection, do not occur if the patient is anesthetized. It may well be that such reactions proceed from the autonomic centres which I have described.
The conclusion to be drawn from these cases of autonomic epilepsy is that there are represented in the diencephalon blood pressure control, heart rate control, vascular dilatation, sweating, salivation, lacrimation, control of respiration, pilomotor reactions, shivering, hiccuping and yawning, and perhaps micturition and the production or urticaria.
Experimental physiologits have timidly pushed localization of autonomic function upward from spinal cord and bulb to mesencephalon until finally they also have burst into the diencephalon with enthusiastic abandon.

Né à Spokane dans l'État de Washignton, aux États-Unis, il arrive au Canada en 1928. Il se joint par la suite à l'équipe de chercheurs de l'hôpital Royal Voctoria de Montréal. Ses recherches portent surtout sur le traitement de l'épilepsie. Avec un don de 1 million de dollars reçu de la fondation Rockfeller, du gouvernement du Québec et de la ville de Montréal, il fonde en 1934 l'Institut de neurologie de Montréal. Cet établissement est associé à l'Université McGill. L'Institut de neurologie de Montréal, qu'il dirige jusqu'en 1960, devient un centre international pour la recherche, l'enseignement et le traitement des maladies du systèmes nerveux.
 Dr. Wilder Penfield revolutionized the techniques of brain surgery and made major discoveries about human cognition, memory and sensation.
Penfield's medical exploration began with the causes and treatment of epilepsy, which was considered incurable. In 1935 he set up the Montreal Neurological Institute, which brought together surgeons and scientists for cooperative projects in the research, diagnosis and surgical treatment of brain disorders.
At the Institute, Penfield perfected his "Montreal Procedure." Applying only a local anaesthetic, he would probe the exposed brain tissue. Guided by the responses of the patient, Penfield would search for the scarred tissue that caused the epilepsy. This procedure also revealed specific functions performed by various unmapped regions of the brain. Penfield discovered the source of memory, tapped the reservoir of long forgotten sensations and emotions, and located the storehouse of dreams. See the video
Improvements in brain tumor surgery: the modern history of awake craniotomies
Ketan R. Bulsara et al. Neurosurgical Focus 2005; 14; 4; 1-5
Dr. Wilder Penfield révolutionna les techniques de chirurgie du cerveau. Il est l'auteur de découvertes importantes portant sur la mémoire, la sensibilité et la douleur, la cognition.
Ces travaux commencèrent en recherchant la cause et le traitement d'épilepsies jusqu'alors incurables. Il fonda l'Institut neurochirurgical de Montreal en 1935, original par l'association de chirurgiens, physiologistes et chercheurs au sein de la même structure vouée tant à la recherche, qu'aux diagnostics et aux traitements de la pathologie cérébrale.
C'est à l'Institut que Penfield perfectionna "la procédure montréalaise". Recourant à la seule anesthésie locale, il enlevait le volet osseux, mettant à nu le cerveau. Guidé par les réponses du patient, il recherchait la région génératrice des crises. Cette technique lui permit aussi d'apporter sa contribution à l'ère des localisations cérébrales tant pour la mémoire que pour les émotions. Voir la vidéo.
Andy OJ, M Jurko Diencephalic Seizure Appl Neurophysiol 1983; 46; 62-67
Flechter S; Cohen F; Borenstein F; Regev I; Vardi J; Yawning as a paroxysmal sign of diencephalic seizures. Archivio di Psicologia Neurologia e Pichiatria 1982; 43; 45-54
Penfield W, Jasper H Diencephalic autonomic seizures Eplilepsy and the functionnal anatomy of the human brain Little Brown et copany - Boston 1954
Penfield W The influence of the diencephalon and hypophysis upon general autonomic function
Walusinski O Yawningas aparoxysmalsignof diencephalic seizures an original observation
w penfield
Wilder Penfield (left) and William Cone
Royal Victoria hospital 1932
penfield jasper
Wilder Penfield and Herbert Jasper 1954