1Department of Neurosurgery, University of Tennessee Health Science Center, Memphis.
2Neuroscience Institute, Le Bonheur Children's Hospital, Memphis.
J Neurosurg. 2021 Sep 24;136(4):1179-1185. doi: 10.3171/2021.4.JNS21218. Print 2022 Apr 1.
Although literary depiction of brachial plexus injury can be traced to Homer's Iliad, there is a scientific consensus that the first clinical description of brachial plexus palsy was not documented until the British physician Smellie reported it in the 18th century. However, the authors' recent review of the Syriac Book of Medicines (12th century) has uncovered a much earlier clinical documentation.
For this historical vignette, the authors reviewed the historical and anatomical literature regarding earlier descriptions of brachial plexus anatomy and pathology, including a thorough analysis of the Syriac Book of Medicines (attributed to an unknown Syriac physician in the Middle Ages) and Galen's On Anatomical Procedures and On the Usefulness of the Parts of the Body.
Building on the galenic tradition with reference to independent dissections, the Syriac physician discussed nervous system anatomy and the clinical localization of neurological injuries. He described a patient who, after initial pulmonary symptoms, developed upper-extremity weakness more pronounced in the proximal muscles. His anatomical correlation placed the injury "where the nerves issue from the first and second muscles between the ribs" (scalene muscles), are "mixed," and "spread through many parts." The patient's presentation and recovery raise the possibility of Parsonage-Turner syndrome. The anatomical description of the brachial plexus is in line with Galen's earlier account and step-by-step surgical exposure, which the authors reviewed. They also examined Ibn Ilyas' drawing of the brachial plexus, which is believed to be a copy of the earliest artistic representation of the plexus.
Whereas the Middle Ages were seen as a period of scientific stagnation from a Western perspective, Galen's teachings continued to thrive and develop in the East. Syriac physicians were professional translators, clinicians, and anatomists. There is evidence that brachial plexus palsy was documented in the Syriac Book of Medicines 6 centuries before Smellie.
尽管荷马的《伊利亚特》中就有对臂丛神经损伤的文学描述，但科学界普遍认为，直到 18 世纪英国医生斯莫利报告了臂丛神经麻痹的首例临床描述，才对此有了科学记载。然而，作者最近对《叙利亚医药书》（12 世纪）进行了回顾，发现了更早的临床记录。
为了进行这个历史特写，作者回顾了有关臂丛神经解剖和病理学的历史和解剖学文献，包括对《叙利亚医药书》（归因于中世纪一位不知名的叙利亚医生）和盖伦的《解剖程序》和《身体各部分的用途》的深入分析。
在盖伦的独立解剖传统的基础上，叙利亚医生讨论了神经系统解剖和神经损伤的临床定位。他描述了一位患者，最初出现肺部症状后，上肢无力，近端肌肉更为明显。他的解剖学关联将损伤定位在“神经从第一和第二肋骨之间的肌肉发出的地方”（斜角肌），“混合”，“分布在许多部位”。患者的表现和恢复提示可能患有帕森斯-特纳综合征。臂丛神经的解剖描述与盖伦早期的描述以及作者回顾的逐步手术暴露一致。他们还检查了伊本·伊利亚斯（Ibn Ilyas）绘制的臂丛神经图，据信这是该神经丛最早的艺术表现形式的副本。
从中世纪的西方视角来看，这一时期被视为科学停滞不前的时期，但盖伦的教义在东方继续蓬勃发展。叙利亚医生是专业的翻译、临床医生和解剖学家。有证据表明，臂丛神经麻痹在斯莫利之前的 6 个世纪就被记录在《叙利亚医药书》中。
