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The Tentorial Nerves And Localization Of Intracranial Pain In Man

W. Feindel, W. Penfield, F. Mcnaughton
Published 1960 · Medicine

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HEADACHE AND HEAD PAINS are perhaps among the most common symptoms with which the physician must deal. Better understanding and improved treatment of headache will depend in large measure upon extending our knowledge of the anatomy and physiology of pain-sensitive structures within the head. Previous evidence has indicated that the dura mater is exquisitely sensitive to painful stimulation along the middle meningeal vessels and dural sinuses and at the sites where cerebral veins enter these sinuses. The innervation of these structures and their implication in dural headache were previously reported by Penfield,’ McNaughton,2 and Penfield and M~Naughton,~ and there is no need to cite again the literature reviewed in these reports and in those of Ray and W0lff4 and Wolff.6 It may be noted, however, that the earliest written symbols for dura, from which so much head pain is derived, are found in the Edwin Smith Papyrus, which is an annotated version made in 1700 B.C. of material dating back about five thousand years.6 The ardent bibliographer might well take this ancient series of neurosurgical cases as a starting point for his survey of the relevant literature. The hieroglyphics for meninges occur in one of the case reports describing a patient with a compound depressed skull fracture, the translation reading in part, “the smash is large, opening to the interior of his skull, (to) the membrane enveloping his brain, so that it breaks open his fluid in the interior of his head.” To the unpracticed eye, the symbols appear (Fig. 1) as 2 wavy lines above 2 semicircles, followed by a symbol resembling a hammer. The neurologist or neurosurgeon, unlearned in Egyptology, might be forgiven for taking the waves to indicate cerebrospinal Fig. 1. Egyptian hieroglyphics, the first written symbols for meninges, from the Edwin Smith Papyrus (redrawn from Breasted’)
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