apoplexy In modern usage, apoplexy and stroke are synonymous terms, referring to sudden and lasting impairment of brain function caused by obstruction of or haemorrhage from the cerebral blood vessels. Cerebrovascular disease is characterized by dramatic physical effects, high mortality, and serious long-term morbidity. Several ancient Greek medical authors, including Hippocrates and Galen, wrote on ‘apoplexy’, leaving careful descriptions of its clinical characteristics. There has, moreover, long been an appreciation that the study of the disorders of the brain might shed light on the nature of mental processes.

The roots of our understanding of the cerebrovascular circulation in disease may be found in the work of the seventeenth-century Swiss physician and anatomist, Johannes Wepfer, who was the first to propose, on the basis of post-mortem examination, that cerebral haemorrhage was a cause of apoplexy. He also suggested that the disorder could arise if the arteries supplying the brain were occluded by blood clots. Apoplexy, in Wepfer's usage, was a wider concept than the modern category of stroke, including cases caused by disease of the cervical arteries. This explains his belief that the damage caused by apoplexy could impair function on both sides of the body.

Apoplexy cases, with their obvious and circumscribed brain lesions, were of great interest to the early pathological anatomists. In eighteenth-century Italy, Giovanni Morgagni demonstrated conclusively that damage within a cerebral hemisphere produced paralysis on the opposite side of the body. In the nineteenth century, the study of stroke lesions played a major role in the localization of specific functions to particular sites within the brain: the French surgeon Paul Broca, for example, correlated loss of speech with localized damage to the base of the third frontal convolution of the left hemisphere. Stroke lesions are generally more discrete and more stable throughout the remaining life of the subject than other forms of damage to the human brain. Experiments upon animal brains can shed little light on the human characteristics of language, personality, and creativity. Strokes thus have functioned, for neuroscientists and psychologists, as ‘natural experiments’ on the human brain.

As well as being physically handicapped, stroke victims often suffer severe psychological effects. The prognosis of stroke has long been regarded very pessimistically indeed. The Hippocratic dictum that ‘It is impossible to cure a severe attack of apoplexy and difficult to cure a mild one’ may be found often reiterated in twentieth-century medical textbooks. However, in the last decade, a mood of greater optimism has emerged. This was first stimulated by developments in stroke rehabilitation, which confirmed the possibility of functional improvement. Also, increased understanding of the pattern of occurrence and the causes of cerebrovascular disease has stimulated interest in the prevention of stroke, with attention being given to the risks of smoking, hypertension, and cardiac disease.

Malcolm Nicolson

ap·o·plex·y / ˈapəˌpleksē/ • n. (pl. -plex·ies) dated unconsciousness or incapacity resulting from a cerebral hemorrhage or stroke. ∎ inf. incapacity or speechlessness caused by extreme anger.

apoplexy sudden loss of powers of sensation and motion. XIV. — (O)F. apoplexie — late L. apoplēxía — Gr. apoplḗxíā, f. apoplēssein disable by a stroke.
So apoplectic(al) XVII.

apoplexy (ap-ŏ-plek-si) n. see stroke.