Loma Linda University

Some Descriptive Concepts of Conscious Man. George Austin and William Hayward. Section of Neurosurgery, Loma Linda University, Loma Linda, California, No date, manuscript, 3 pg

Austin, George

Hayward, William

Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works The Dr. George M. Austin Neurology Research Collection Special Collections and Archives 1000 Some Descriptive Concepts of Conscious Man George Austin Section of Neurosurgery, Loma Linda University William Hayward Section of Neurosurgery, Loma Linda University Follow this and additional works at: https://scholarsrepository.llu.edu/george-austin-collection  Part of the Neurosciences Commons Recommended Citation Austin, George and Hayward, William, "Some Descriptive Concepts of Conscious Man" (1000). The Dr. George M. Austin Neurology Research Collection. 50. https://scholarsrepository.llu.edu/george-austin-collection/50 This Manuscript is brought to you for free and open access by the Special Collections and Archives at TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in The Dr. George M. Austin Neurology Research Collection by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact scholarsrepository@llu.edu. "SOHE DESCRIPTIVE CONCEPTS OF CONSCIOUS MAN" George Austin & William Hayward Section of Neurosurgery Loma Linda University Loma Linda, California Current interest in developing improved cybernetic models of conscious man prompts us to inquire more deeply into the interlocking anatomic, physio-logic, and philosophic implications which must be considered. It is no longer profitable nor useful to refute certain questions as to whether qualitative . values of thought such as joy, envy, sadness, etc. can be quantitated, nor to deny the critical nature of inductive thought and ideational thinking as important in distinguishing the mentation of conscious man from that of our more sophisticated models. -· Conscious man in the normal range is aware of knowing multiple percep-tion~ at any instant. This is in contradistinction to the a~tomatisms of psychomptor seizures, types of daydreaming, and sleepwalking in which percep-tion occurs but for which there is no demonstrable recall. It is assumed that speech is an observable form of behavior, that perception by affirmative vocalization presupposes knowledge of an event, and that descriptive comnuni-cation of, and awareness of knowing an event are different exclusive aspects of the same thing. We can then approximate a function·of the general level of knowing by discriminative testing and other language probings, based on the additional formulation that there should exist no sensory dysphasia and that human speech ,is man's most sensitive form of language. This presupposes that the level of awareness of knowing at a given time is proportional to the connnunicated description of the external world. Such an approach permits us • , to conveniently grade depressed conscious man into testable levels of con-fusion~ stupor, and coma for purposes of clinical evaluation. To some extent ,,. .... . -2-the;,,e may be further related to brain anatomy and physiology as observed and studied under pathologic conditions. We have measured certain experimentally observed features of man's brain function which may serve as guideposts in developing hypotheses and future brain models: a. From head injury patients with uncomplicated concussions we observe ·- that, associate~ with the transient loss of consciousness, there follows a limited period (varying from days to seconds) of gradually decaying retrograde and post-traumatic amnesia, demon-strated by the patient's communicating to us inability to recall just prior and just aftef events. This implies that the recall or memory mechanisms are more sensitive than the filing of percep-tions. b. Total surgical removal of the nondominant hemisphere (approximately 1/3 of total brain mass) under local anesthesia evokes no change in the patient's conscious state during or following the opera-tion. Further, there is no chan~e in the patient's intellectual function as measured by the usual psychological testing. Removal of the terminal 6 cm. of either temporal lobe, frontal lobe, or , occipital lobe fails to alter the patient's communicated descrip-tion of general awareness, although it may affect specific percep-.. tions (visual or auditory). c. Interruption, by chemical leucotomy bilaterally, of the frontal ideational cortex connections to the thalamus (medialis dorsalis nucleus) shows a significant depression of all modalities of intensity discrimination including time perception. d. Electrical stimulation of the thalamus (ventralis lateralis nucleus) during stereotatic surgery can produce complete mutism for periods up to two minutes, but, as shown by appropriate verbal testing, this does not block the patient's filing and recall of information r I -3-received during this period of mutism. The effects of diffusely and progressively eradicating brain function, i.e. total cerebral blood flow reduced to less than 60 percent of normal, or generalized cerebral edema, or diffuse hyponatremia, etc., gradually induce confusion, stupor, and coma in that order. (Confusion being arbitrarily described as a state of responsiveness in which there is a prolonged latency in response to verbal stimulation, and where the communicated response shows inaccuracy and poor orientation; stupor being a condition in which the patient either tends to fall asleep or is in a sleep-like condition from which he may be aroused by appropriate stimulus; coma, a sleep-like condition in which the patient cannot be stimulated to respond for communication, no matter how strongly the stimuli are applied.) Studies on time perception during condi-tions of stupor show a consistent underestimation during the emergence from a prolonged stupor such as that encountered in long-term experimental cave dwellers. This is opposite to the time perception of patients with Parkinson's disease who experience an overestimation and exaggerated time sense. The gross nonlinearities and the stabilities of multiple levels of discrimination, which we find when experimentally testing intensity discrimi-nation ability in patients, suggest that in a systems analysis model of the problem of perception in man, one should consider nonlinear systems capable of multiple levels of both amplitude and frequency stability in an N-dimen-sional attribute or perception space. It further suggests that this exists in at least an (N+l) awareness space~ , I ,i ', .... •- .; _,.. 

English

Some Descriptive Concepts of Conscious Man

Intracranial Aneurysm-Early Diagnosis and Prevention of Rupture. George M. Austin. 1 p

Austin, George M.

Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works The Dr. George M. Austin Neurology Research Collection Special Collections and Archives 1000 Intracranial Aneurysm-Early Diagnosis and Prevention of Rupture George M. Austin Follow this and additional works at: https://scholarsrepository.llu.edu/george-austin-collection  Part of the Neurosciences Commons Recommended Citation Austin, George M., "Intracranial Aneurysm-Early Diagnosis and Prevention of Rupture" (1000). The Dr. George M. Austin Neurology Research Collection. 54. https://scholarsrepository.llu.edu/george-austin-collection/54 This Lecture is brought to you for free and open access by the Special Collections and Archives at TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in The Dr. George M. Austin Neurology Research Collection by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact scholarsrepository@llu.edu. "INTRACRANIAL ANEURYSM-EARLY DIAGNOSIS & PREVENTION OF RUPl'URE" George H. Austin, H.D. I. Prevalence: Varies from 1%-10%, Av.~5%, at consecutive autopsy for all causes. 30% show. evidence of previous leak or rupture • •• II. Incidence: Those admitted to hospital following rupture ~pproximately 10/100,000/year, with overall mortality from all causes, 60% within first month. Therefore most leaks go undetected, undiagnosed, or die out of hospital. Multiple• 15%-20% Loculated•l7% III.To Diagnose before rupture: A. Accidental finding at Angiography. B. From suspicion and differential diagnosis. I) HEADACHES: flu, migraine, anxiety, eye strain; sinusitis. II) NECK PAIN: cervical disk, meningitis, flu, "wry neck. III) FAMILY HISTORY: Family history of aneurysm·. IV) ASSOCIATED DISEASES: polycystic kidney, Marfan's Disease; Collagen Disease, (Type II or III Deficiency). IV. Diagnostic Methods: V. MANAGEMENT: 1) CT with contrast 2) MRI Scan 3) L.P., up to 5 weeks(+) for cellular iron staining after bleed. 4) Angio :p If less than 10 mm. diameter (Av.size of rupture• 21 mm) .i) Followcscan q. 6 mos. and with experienced neurosurgeon • . ~U Lower B.P. III) Consider common carotid ligation IV) Consider common carotid stenosis to drop B.P. by 50% :rt') If greater than 10 mm. in diameter consider surgery 

Intracranial Aneurysm-Early Diagnosis and Prevention of Rupture

Stereotaxic Surgery with Computer Tomography for Diagnosis and Treatment of Brain Lesions. George Austin, M.D. N.d. 1 typewritten manuscript

Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works The Dr. George M. Austin Neurology Research Collection Special Collections and Archives 1000 Stereotaxic Surgery with Computer Tomography for Diagnosis and Treatment of Brain Lesions George M. Austin Follow this and additional works at: https://scholarsrepository.llu.edu/george-austin-collection  Part of the Neurosurgery Commons Recommended Citation Austin, George M., "Stereotaxic Surgery with Computer Tomography for Diagnosis and Treatment of Brain Lesions" (1000). The Dr. George M. Austin Neurology Research Collection. 48. https://scholarsrepository.llu.edu/george-austin-collection/48 This Manuscript is brought to you for free and open access by the Special Collections and Archives at TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in The Dr. George M. Austin Neurology Research Collection by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact scholarsrepository@llu.edu. ( ( STERF.OTAXIC SURGERY Wlffl COHPlrl'ER TOMOGRAPHY FOR DIAGNOSIS A.ND TREA'IMENT OF BRAIN LF.SIONS George Austin, H.D. Santa Barbara, California Definition: Orientation and placement of a needle into an anatomically defined target within the brain substoma. The target may be defined anatomically with X,Y,Z, coordinates from an anatomic atlas of the brain or it may be defined from a CT image. In either case it is defined and related to X,Y, and Z axes from a zero reference point. The first stereotaxic instrument was described and invented (1908) in London, England by Sir Victor Horsely, England's first neurosurgeon, and William Clark a friend of Horsely's who was a hat manufacturer. This instrument was designed and used on cats for making small precise lesions in brain stem nuclei. In 1941 the first steriotaxic instrument designed for human application was described and used by E. Spiegel and H. Wyeis. Leksell, a Swedish Professor of Neurogurgery first described his Model I instrument in 1945. The current Model IV is the one we use today and is based on a hemispheric arc along which the needle carrier travels, with the target always located at the centre of the hemisphere. This enables the surgeon to enter the skull through a small burr hole that can be oriented away from the sensory-motor functional cortex. Stereotactic placement of a needle tip enables this surgeon to biopsy a mass lesion without damage to the patient, through a small burr hole. The following questions are answered: 1. Is it a tumor? 2. If a tumor, is it cystic? 3. Is it benign or malignant? 1 4. If malignant, is it primary or metastic? 5. If primary, can we grade the malignancy? Other lesions which may be visuallized on CT scan and safely diagnosed by needle biopsy include Toxoplasmosis. Herpes Encephalitis, Benign cysts, Intracerebral hemorrhages, Brain abscess, and Lymphomas. The advantages of the technique lies in its simplicity, the fact that it is done under local anesthesia, short hospital stay (discharge the day following surgery), and high probability of success, (about 85%). If a brain tumor is biopsied, immediate smears are made and examined by the pathologist. Further biopsies with the same needle can be obtained if required. Usually enough material is also obtained for paraffin block section. These slides can be examined the next day. Depending on ·the diagnosis, further studies may be indicated if the tumor is considered metastatic, If a primary brain tumor is biopsied and diagnosed, a decision is made as to whether craniotomy is in9icated for removal, or whether to proceed directly with radiation therapy. 

Stereotaxic Surgery with Computer Tomography for Diagnosis and Treatment of Brain Lesions

A manuscript outline of possible inherited disorders presumably created by Dr. Austin. No date

Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works The Dr. George M. Austin Neurology Research Collection Special Collections and Archives 1000 Inherited Disorders George Austin Follow this and additional works at: https://scholarsrepository.llu.edu/george-austin-collection  Part of the Neurology Commons, and the Neurosurgery Commons Recommended Citation Austin, George, "Inherited Disorders" (1000). The Dr. George M. Austin Neurology Research Collection. 43. https://scholarsrepository.llu.edu/george-austin-collection/43 This Manuscript is brought to you for free and open access by the Special Collections and Archives at TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in The Dr. George M. Austin Neurology Research Collection by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact scholarsrepository@llu.edu. .-,. INHERITED DISORDERS I. Single gene human defects: 1. 2. 3. Autosomal dominant inheritance: in general the following rules apply: a. Every Affected person has at least one cjffect.eJ parent. An Offect~ person marrying a normal individual has only~n. ave!'~'i) equal number of ,f f ected and normal children. ~ 41h Normal children of an ~ff ectf-tk parent have normal children and grandchildren. 4. Males and females are equally likely to betiffected. 5. The trait can appear in every generation. 6. Heterozygotes are ~ffected. Variat4on!in these rules are as follows! OneA~alled expressivity at '§ER '\ and A penetrance: the effects of a single gene defect may be influenced both by the individual's environment and by thousands of other genes that may alter the phenotypic expression of a genii-' ~~aaei"'{l. A typical example of this is Waardenbur~syndrome in which the patient has a white forelock, deafness, abnormal iris and some hearing loss. However, the individual may have none of these ', because the dominant gene has been modified. The situation in which the expressivity is close to nil is called the lack of penetrance or forme fruste of the__,,disease. 2. Pleotropy (meaning many forms): In this condition a single genetic defect may produce multiple anomalies. For example, there may be an abnormality of connective tissue with various structures involved such as Marfan's syndrome with multiple bone anomalies, hyperextensible fingers and toes and excessive elasticity of the skin. 3 . Mutations These arrive spontaneously from time to time. About 80% will have no family history· and, therefore, would be expected to represent a fresh mutation. In general the unaffected parents are not at increased risk of having additional effected offspring. 4. Phenocopies In this situation (very rare), an individual appears with a syndrome. The syndrome appears to be due to a non-genetic phenomena or at least to a different genotype. 5. Sex limited inherence This is a trait that appears in only one sex and there is sex limited. Males are almost always sex effected, usually because of X-linked inheritance. Examples of this are premature baldness. 6. Homozygous dominant genotype This can occur in the offspring of two individuals who are heterozygous or homozygous for the same dominant gene. The availability of gene markers were Huntington's disease has shown that there are no phenotypic differences between heterozygotes and homozygotes for this dominant condition. A homozygote would have 100% of the offspring effected. AUTOSOMAL RECESSIVE INHERITANCE The following rules apply: 1. If an effected person is born to normal parents, both parents are heterozygotes, and on the average one-quarter of their offspring will be effected. One half will be heterozygotes and one-quarter will be normal. 2. If effected siblings come from a consanguineous marriage, there is good evidence of recessive inheritance. 3. If an effected person and a normal genotype marry, all of their children will be phenotypically normal heterozygotes. 4. If an effected person and a heterozygote marry, on the average one-half of the children will be effected and one-half will be heterozygotes. 5. If two effected people marry, all of their children will be effected. 6. Males and females are equally likely to be effected. ' 7. Heterozygotes are phenotypically normal but carriers of the trait. II. MULTI-FACTORIAL INHERITANCE This is a condition where close relatives tend to resemble each other with respect to a number of quantitative or measurable characteristics such as height, weight, size and shape of nose and other facial features, blood pressure and intelligence. Most of the time the variations in population result from a number of genes and environmental factors acting together to determine the final result. A large number of relatively common congenital anomalies and diseases that are fairly familial do not fit the expectations for mendelian inheritance and most likely these conditions result from multi-factorial inheritance of a continuously distributed variable. In these situations the effected patient has a liability or predisposition to the condition representing the sum of genetic and environmental influences (possibly intracranial aneurysms). This concept explains the relatively high risk of the trait in the first degree relatives, i.e., children and siblings who share 50% of their genes and the much lower risk to the more distant relatives who are lucky to inherit only a few of the high liability genes. Other examples of multi-factorial inheritance with similar risks for siblings and offspring of effected individuals are congenital vascular anomalies, idiopathic epilepsy, congenital megacolon and cases of cleft lip and many forms of cancer. At present attention is being focused on a group of common disorders with multi-factorial cause such as arteriosclerotic heart disease, diabetes mellitus, cancer and arthritis. Genetically determined predisposing factors and biochemical and molecular phenomena are being used to identify individuals at increased risk who would be most likely to benefit from preventive measures such as the use of drugs, special diets, changes in lifestyle and changes in occupation. We can, therefore, say that phenotypically similar conditions can be due to different mutations, non-genetic factors or combinations of both. Therefore, to determine the risk to future offspring, a physician must take a very thorough family history including an??? possible environmental \ ('1 

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Some Descriptive Concepts of Conscious Man

Intracranial Aneurysm-Early Diagnosis and Prevention of Rupture

Stereotaxic Surgery with Computer Tomography for Diagnosis and Treatment of Brain Lesions

Inherited Disorders

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4,754