“A History of Twentieth Century Neuroradiology in Uruguay and Its Far-Reaching Influence in Latin America”

ORIGINAL ARTICLE “A HISTORY OF TWENTIETH CENTURY NEURORADIOLOGY IN URUGUAY AND ITS FAR-REACHING INFLUENCE IN LATIN AMERICA”. Angélica Wozniak Eduardo Wilson INTRODUCTION When we were invited to describe Fischgold, around the middle of the the history of neuroradiology in twentieth century. (3) Uruguay for the Regional Erik Lindgren, who at a later date Conference of Neurohistory taking was likewise considered the father place in Montevideo in September of neuroradiology, wrote the chapter 2012, we made the project of writing entitled “History of Neuroradiology” on the subject. (1) We later wrote in “Radiology of the Skull and this account that only includes the Brain”, the classic text of Newton events that took place during the and Potts. This book was published twentieth century. in 1971, just before Computerized Although the History of Tomography was discovered. neuroradiology is quite well known, Lindgren considers that a brief summary is mandatory. It neuroradiology came into being began with the discovery of X-rays when Dandy performed, in 1918, the by Roentgen in 1895. In 1896 a air injection that marked the Swedish physician, Dr. Stenbeck, beginning of took anterior-posterior and lateral pneumoencephalography. Lindgren views of the skull, which enabled considered that the preceding stage, him to detect a projectile in the which included pioneering occipital region. The patient was experiences, belonged to the operated because of that finding, general development of Radiology. and the location of the bullet was The use of contrast implied new confirmed. (2) advances; contrast was now Later on, several milestones marked injected into arteries. In 1927, Egas the development of neuroradiology. Moniz proposed a new method for An important one would be the the study of intracranial structures: visualization of a calcified pineal injection of a positive contrast agent gland by Schuller in 1906. On into the carotid artery. In this way account of this achievement, among cerebral angiography began, which other contributions to skull signified a huge advance in radiology, Schuller was considered neurological diagnosis. the father of neuroradiology by Many years later Computerized several authors like Bull and Tomography (CT) came along, Revista Uruguaya de Imagenologia Ene-Jun 2014, XVII (2):101-109 2 “A HISTORY OF TWENTIETH CENTURY NEURORADIOLOGY IN URUGUAY AND ITS FAR-REACHING INFLUENCE IN LATIN AMERICA” allowing a direct vision of brain During the second stage, contrasted pathology for the first time. We images of intracranial and spinal might say that Computerized canal structures are obtained. Tomography was the greatest These structures are the ventricles medical discovery of the twentieth and the subarachnoidal spaces, century. It brought about a which are evidenced by filling them revolution in medical knowledge. with air (pneumoencephalography, The leading player in this process pneumomyelography) or with was Sir Godfrey Hounsfield in 1972. positive contrast agents He received the Nobel Prize for (angiography). Alterations and shift Medicine and Physiology in 1979, of these structures lead to the along with Allen McCormack. detection of anomalies and their Later on Magnetic Resonance (RM) localization. was developed; it offered a more During the third stage, imaging of defined image, multiplanar brain parenchyma becomes acquisition, the possibility of possible (CT, MR) and now the functional imaging and topography and the nature of brain spectroscopy. Mathematicians, lesions can be pinpointed. physicists, engineers and physicians During the fourth stage the all took part in its genesis, because possibility arises to define functional they developed concepts apparently brain alterations by imaging unrelated and with no immediate (functional neuroradiology). applicability, which were blended NEURORADIOLOGY IN together by their joint efforts, URUGUAY achieving a technique based on These stages will be our starting contributions from all those fields. points for this account of the history The first application of MR was of neuroradiology in Uruguay. spectroscopy, which was based on Evidently, as new techniques the same principles. Imaging itself, appear, they join the existing ones, that is to say MRI, was developed which also continue to develop and somewhat later. Many of the progress. scientists who in the course of Stage I: Bone Imaging of skull several years described these and spine. findings were awarded the Nobel A few weeks after X-rays were Prize. discovered, X-ray films were being The last acquisitions in the field of made in the “Río de la Plata” region functional imaging were: MR (4). One year later, in 1897, came spectroscopy, PET (positron the first request of a radiograph from emission tomography) and a physician. Photographs of interventional imaging (for vessels radiographs were included in and tumors). doctoral theses; the first of these We can identify several stages in was registered in 1899. The first the development of neurological radiograph of a patient to be diagnosis. published in a medical journal The first stage corresponds to bone appeared in the year 1900 (4). imaging of the skull and the spinal There was no Radiology Chair yet, column. Bone deformations, but there were X-ray rooms in some fractures and calcifications could be of the clinics at the Hospital de diagnosed. Caridad, with one physician taking responsibility for all studies, [Dres. A. Wozniak, E. Wilson] ORIGINAL ARTICLE including radiographs of skull and He himself took the first radiographs spine. Equipments were scarce and ever to be published in theses and primitive, and they were chiefly used publications at the end of the for radioscopy. At the turn of the nineteenth century and the century there were X-ray beginning of the twentieth century. equipments in both the Hospital de Later on he became Professor of Caridad and some private practices. Obstetrics at the Faculty of First Augusto Turenne, then Medicine, Dean of the said Faculty Leopoldo Thévenin were the and first president of the physicians' physicians responsible for the X-ray union (Sindicato Médico del rooms at the hospital, until the Uruguay) (5). Radiology Institute was created in Leopoldo Thévenin (1878-1912): 1913. In addition, some private As soon as he graduated, on August medical practices had X-ray 12,1905, he went to France and equipments. there he decided to become a Augusto Turenne (1870-1948): He radiologist. He came back two years was the director of the first later, bringing X-ray equipment Radiology Laboratory, which was which he donated to the Hospital de created in 1899, as a development Caridad, in order to establish a of the Laboratory for Photography specialized department there. The and Microphotography at the new Radiology Department began Hospital de Caridad. Turenne to operate in 1908, under the supervised the work and attended direction of Thévenin. It preceded personally to the Radioscopy and the Radiology Institute. It was both a Microphotography sections. replacement and an improvement on the department managed by Turenne. By then, Turenne as a successful obstetrician had lost interest in Radiology (6). Stage II: contrasted imaging of intracranial and spinal structures We can identify two periods within this stage. In the first one we will remember the pioneers. In the second one we will review the advent and development of the School of neuroradiology of Montevideo and its far-reaching influence in Latin America. • The pioneers: Figure 1.- Hydatid cyst of the brain. – These were radiologists who Ventriculography performed by Dr. worked, as a rule, side by side with Alejandro Schroeder by means of air surgeons and physicians. It fell to injection into the lateral ventricle and the surgeons and physicians to perform cyst. A cyst with neat contours is seen, the procedures on the patients, such markedly compressing the lateral as puncturing and injecting the ventricle and displacing the septum ventricles or the subarachnoid pellucidum towards the right. space, while it was the radiologist who took the radiographs, adjusting Revista Uruguaya de Imagenologia Ene-Jun 2014, XVII (2):101-109 4 “A HISTORY OF TWENTIETH CENTURY NEURORADIOLOGY IN URUGUAY AND ITS FAR-REACHING INFLUENCE IN LATIN AMERICA” the position of the patient and injection of air or iodine contrast. choosing the technique These cases were published in 1939 (8,9). His coworker was Juan Cunha was perhaps the first radiologist Nicolás Caubarrere, the Uruguayan radiologist to take an successor of Cunha. After being interest in the diagnosis of appointed Professor and Director of neurological disorders. Having the Neurology Institute in 1937, graduated in 1913, Juan Cunha Schroeder incorporated showed an early interest for encephalographic studies to the Radiology. He was the radiologist of routine diagnostic procedures for the Neurology Institute since it was encephalic tumors and did likewise created in 1927. He performed the with myelography and the disorders first contrast studies at the Institute: of the spinal cord. myelographies in 1927 and 1928, as In May 1936, Eduardo Palma as well as the first neurosurgeon and Eugenio pneumoencephalography in March Zerboni as radiologist performed 1929. He was also the radiologist of the first cerebral angiography by the clinic of Professor Navarro and percutaneous carotid puncture, the director of the Radiology using Thorotrast as a contrast Department at the Hospital Pedro agent. It was communicated to the Visca. He was appointed

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