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Updated: Jun 19, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Chapter 27: a history of cerebrovascular disease
Catherine E Storey1, Hans Pols
1Department of Neurology, Royal North Shore Hospital, St. Leonards, Australia. cstorey@nsccahs.health.nsw.gov.au
Insights
Stroke, historically known as apoplexy, has evolved from humoral imbalance theories to understanding its vascular basis. Advances in stroke medicine, particularly C. Miller Fisher's work, led to effective treatments replacing historical therapeutic nihilism.
Area of Science:
- Neurology
- Vascular Medicine
- Medical History
Background:
- Stroke, historically termed apoplexy, has ancient roots in medical literature, with early theories attributing it to humoral imbalances.
- 17th-century work by Wepfer and Willis began establishing a link between intracranial hemorrhage and cerebral arteries, shifting the understanding of apoplexy.
- 19th-century clinico-pathological studies solidified the vascular basis of stroke, leading to the abandonment of the term 'apoplexy' in favor of 'cerebrovascular accident' and 'stroke'.
Observation:
- Early stroke management in the 19th century was characterized by limited efficacy and a reliance on practices like bloodletting.
- Therapeutic nihilism, a belief in the ineffectiveness of treatments, largely dominated stroke care into the 20th century.
- The mid-20th century marked a turning point with C. Miller Fisher's research highlighting the carotid artery's role in stroke.
Findings:
- Fisher's work recognized the critical importance and therapeutic implications of the carotid artery in stroke pathogenesis.
- This recognition spurred the development of stroke medicine as a distinct specialty.
- The understanding of stroke's vascular basis paved the way for developing a wider range of therapeutic interventions.
Implications:
- The evolution of stroke understanding transformed management from therapeutic nihilism to active intervention.
- Stroke medicine has advanced significantly, offering a growing armamentarium of treatments for patients.
- Continued research into cerebrovascular diseases promises further improvements in diagnosis and patient outcomes.
Abstract:
Stroke is central to the history of cerebrovascular disease. References to this condition already appear in the Hippocratic corpus, referred to as apoplexy, which was defined by the clinical presentation: a sudden collapse, a loss of consciousness, a lack of movement, and included a variety of pathologies. A humoral imbalance was seen as the causation. In the 17th century, Johannes Wepfer, a Swiss physician, first demonstrated that apoplexy was caused by an intracranial hemorrhage; Thomas Willis, an English anatomist, explored the role of the cerebral arteries. Stroke became a cerebrovascular disease. By the 19th century, based on extensive clinico-pathological correlates initiated at the Paris Medical School, a vascular basis was firmly established and a range of pathologies determined. Apoplexy was considered too imprecise, and the term abandoned in favor of the term "cerebro-vascular accident" and latterly stroke. Although physicians of the 19th century utilized a wide variety of therapies in the treatment of stroke, with particular emphasis on blood letting, therapeutic nihilism dominated stroke management well into the 20th century. Following the mid 20th century work by C. Miller Fisher, with the recognition of the importance and the therapeutic implication of the carotid artery in stroke, the specialty of stroke medicine came into being. Therapeutic nihilism was replaced by an increasing armamentarium of therapeutic interventions.
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