Kapronczay Károly szerk.: Orvostörténeti Közlemények 198-199. (Budapest, 2007)

TANULMÁNYOK — ARTICLES - SZIRMAI, Imre - GOSZTONYI, Georg: Conceps of Localization of Neurological Functions in István Környei 's Oeuvre. - (Az idegműködések helyhez-köthetöségének elméletei Környei István életművében)

CONCEPTS OF LOCALIZATION OF NEUROLOGICAL FUNCTIONS IN ISTVÁN KÖRN YE Y'S OEUVRE IMRE SZIRMAI - GEORG GOSZTONYI Schools of clinical medicine generally exert strong influence onto their pupils designating not only views and scientific methods but also research topics. However, among the successors those become successful, who are able to remove themselves from the inherent, traditional schemes. Such trends can be revealed in the creative career of Stephen Környey and of a few of his contemporaries. In this review Környey's clinical studies on clinicopathological correlations are surveyed. Környey's concept on neural topography was reasonable: " the question of localization can be raised in two forms: first, which brain areas are necessary for the maintenance of normal functions; second, which neurological signs can consequently be observed during excitation or destruction of definite brain areas" (Környey 1971). Környey pointed out that in Sherrington's and Pavlov's era researchers were predominantly concerned with investigation of "how lower reflex mechanisms are controlled by higher level connections; but today, concerning the cerebral cortex the most conspicuous question of interest is how these functionally different areas integrate their activity." In Környey's developmental work, four topics deserve special attention: /. Disturbances of elementary functions - topography of the spinal cord and the brain stem. His early study on the myelinisation of subcortical structures revealed clearly his ability to analyse complex hodological-developmental relations (Környey, 1927). In a comprehensive chapter (50 pages) written for the Bumke-Foerster's Handbuch der klinischen Neurologie he gave a detailed survey of the brain stem neurological syndromes (Környey, 1936). In a clinico-pathological study of a patient with a meso-diencephalic vascular lesion he analyzed the brainstem control of gaze (Környey, 1959a). He emphasized the importance of the nucleus interstitialis Cajal and of the nucleus commissurae posterioris Darkschewitsch as the subcortical coordination centres of vertical gaze. His findings were consonant with the experimental data of Szentágothai (1943). At the same time, Környey's coworker László Molnár published a similar case with vertical gaze palsy caused by a meso-diencephalic infarct and arrived to the same conclusions concerning the supranuclear system of the vertical gaze (Molnár, 1959). Disorders of the oculomotor system remained the favored topic of Környey's successors (Gosztonyi, 1961; Vastagh et al., 1996; Szirmai et al., 2003). Gosztonyi analyzed a case of unilateral internuclear ophthalmoplegia caused by focal lesion of the