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Running around in circles following ischemic stroke
  1. A N Williams
  1. CDC, Northampton General Hospital, Northampton, UK; anw{at}

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I read Shaffer et al’s paper with great interest, but it gave a strong sense of deja vu.1 The authors and ADC readers may find of interest Sigmund Freud’s comments on this particular topic from his classic Infantile Cerebral Paralysis published in 18972: “The consideration of cranial trauma as another etiological factor defeats all attempts to view hemiplegic cerebral paralysis as a single etiological entity.”

He then cites over 20 cases from the medical literature at that time from Osler, Abercrombie, and Henoch amongst others. He adds: “In a number of cases the role of trauma as an etiological factor of infantile cerebral palsy is indisputable. It would be important for the principal concept of infantile cerebral paralysis, if in definitely traumatic cases there would be specific deviations in the disease from the non-traumatic ones in regard to course or complications. No special study has been undertaken so far in this regard.”

One century after Freud this study has still not been undertaken and thus it is questionable how far further on from Freud, Shaffer et al’s paper moves us forward.