The Tale of Phineas Gage, Digitally Remastered

Abstract

The injury of Phineas Gage has fueled research on and fascination with the localization of cerebral functions in the past century and a half. Most physicians and anatomists believed that Gage sustained a largely bilateral injury to the frontal lobes. However, previous studies seem to have overlooked a few less obvious, but essential details. This has led us to reanalyze the injury using three-dimensional reconstruction and quantitative computer-aided techniques and to propose a new biomechanical model, in order to determine the location and extent of the injury and explain Gage's improbable survival. Unlike previous studies on this subject, our findings are based on computer-generated three-dimensional reconstructions of a thin-slice computed tomography scan (CAT) of Phineas Gage's skull. The results of our image analysis were corroborated with the clinical findings, thoroughly recorded by Dr. Harlow in 1848, as well as with a systematic examination of the original skull specimen. Our results show that the cerebral injury was limited to the left frontal lobe, did not extend to the contralateral side, did not affect the ventricular system, and did not involve vital intracranial vascular structures. Although modern neuroscience has perhaps outgrown the speculations prompted by this famous case, it is still a living part of the medical folklore and education. Setting the record straight based on clinical reasoning, observation of the physical evidence, and sound quantitative computational methods is more than mere minutia and of interest for the broad medical community.

Emotional and Behavioral Symptoms in Neurodegenerative Disease: A Model for Studying the Neural Bases of Psychopathology

“…Debate about the exact anatomy of this injury (Damasio et al 1994, Ratiu et al 2004) and the nature of the associated behavioral change continues to this day (Macmillan 2000). The uncertainty around the injury to Gage’s brain and the associated changes in behavior underscore the importance of having precise ways to characterize both the anatomy of brain injuries and the associated behavioral changes.…”

A mouse model of blast-induced mild traumatic brain injury

“…Mechanisms and consequences of brain injuries have always been a matter of debate and speculation (Ratiu et al, 2004), and even more so when the injury may not easily be identified by technologies used in clinical practice such as in the case of mild traumatic brain injury (mTBI; Sterr et al, 2006). Since the actual mechanisms of injury are still unclear (Bigler 2008; Ruff, 2005), there is controversy regarding diagnostic criteria for mTBI as well as the relationship between mTBI and some manifestations of posttraumatic stress disorder (PTSD; Andreasen, 2004).…”

Integrating precision medicine in the study and clinical treatment of a severely mentally ill person

“…One can learn a substantial amount from detailed study of particular individuals (for just a small sampling, see Sacks, 1995; Sacks, 1998; Luria, 1972; Luria, 1976; Van Horn et al, 2012; Ratiu et al, 2004; Eichenbaum, 2013; Worthey et al, 2011), and we believe that we are entering an era of precision medicine in which we can learn from and collect substantial data on informative individual cases. Incorporating insights from a range of scientific and clinical disciplines into the study and treatment of any one person is therefore beginning to emerge as a tractable, and more holistic, approach, and we document here what we believe to be the first integration of deep brain stimulation and whole genome sequencing for precision medicine in the evaluation, treatment and preventive care for one severely mentally ill individual, MA.…”