Professor Abraham Akerman

Professor Abraham Akerman

Abstracts

The authors present a historical review of the contribution of Professor Abraham Akerman to Brazilian neurology, including the famous sign known as “the Alajouanine-Akerman unstable ataxic hand”.

neurology; history; pseudoathetosis; Brazil; neurologia; história; pseudo-atetose; Brasil

Os autores apresentam uma revisão histórica sobre a contribuição do Professor Abraham Akerman para a Neurologia brasileira, incluindo o famoso sinal “Mão instável atáxica de Alajouanine-Akerman”.

Brazilian neurology was greatly influenced by the French school of neurology. In the nineteenth century, the Salpêtrière Hospital in Paris, France, was considered the mecca of neurology, and Professor Jean-Martin Charcot was considered the father of neurology¹-⁴. The first professors of neurology in Brazil were Dr. Antonio Austregésilo, of the National College of Rio de Janeiro (1912), a pioneer in neurology and movement disorder studies, and Dr. Enjolras Vampré, in São Paulo (1925), who coordinated the neurology and psychiatry clinic at the São Paulo Faculty of Medicine and Surgery, later to become the Faculty of Medicine at the Universidade de São Paulo¹-⁵. Both Austregésilo and Vampré trained in different neurology services in Paris, France, primarily in those coordinated by Charcot's disciples, such as Pierre Marie, Babinski, and Dejerine¹-^{3 5}. Between 1948 and 1960, Professor Théophile Alajouanine occupied the chair of diseases of the nervous system at the Paris Faculty of Medicine⁶. His disciples, who came from all around the world, included Dr. Abraham Akerman, who was from Rio de Janeiro, Brazil.

ABRAHAM AKERMAN

Abraham Akerman, who was of Jewish origin, was born to a family from Eastern Europe in 1908 and came to Brazil as a child, where he lived in the city of Rio de Janeiro⁷–⁹. In 1924, Akerman traveled to Paris, France, and studied in the Faculty of Sciences at the University of Paris. In 1926, he enrolled in the Faculty of Medicine at the same university, going on to graduate in 1930⁷-⁹. After obtaining his PhD from the University of Paris with a thesis on brucellosis in 1933, Akerman went on to train with various leading French neurologists, such as Guillain, Crouzon, Nageotte, and Théophile Alajouanine⁷-⁹. His period with Professor Alajouanine was the most productive, and Akerman considered him to be his true mentor⁷-⁹. Fig 1 shows Professor Alajouanine together with his disciples, among them Professor Akerman, and the complete nursing team in the neurology service, Salpêtrière Hospital.

Fig 1.
Professor Théophile Alajouanine (seated in the center) and his disciples, including Professor Abraham Akerman (arrow).

In 1933, Akerman returned to Rio de Janeiro and worked with professors Antônio Austregésilo, José Ribeiro Portugal, Paulo Niemayer, and, later, Deolindo Couto⁷-⁹. Between 1938 and 1940, he trained in the Department of Neuropathology at the Universidade de São Paulo. In 1956, he became a coordinator of the 34^th Ward of the Santa Casa de Misericórdia Hospital in Rio de Janeiro, where he established a School of Neurology and acquired various disciples, among them Professor Nunjo Finkel^{7 8}. Akerman was a permanent member of the Rio de Janeiro Society of Neurology, Psychiatry, and Forensic Medicine, and in 1952, he was made an honorary member of the French Society of Neurology (on the recommendation of professors Théophile Alajouanine and Jean Lhermitte). In 1970, he was a visiting professor at the Mount Sinai School of Medicine, University of New York. Akerman had a private practice and was one of the most highly regarded and successful neurologists of his time. He died in 1985 at the age of 77⁷-⁹.

AKERMAN'S SCIENTIFIC CONTRIBUTION

Akerman's scientific contribution to neurology in Rio de Janeiro and in Brazil can be judged from the School of Neurology that he established, which had various disciples, and from his involvement with foreign neurology services, initially in Paris, through his great friendship with Professor Théophile Alajouanine, then in London, through his close relationship with Professor McDonald Critchley, later in Germany and finally in the USA (New York) in the 1970s⁷-⁹. Akerman was a host in Rio de Janeiro to many luminaries of international neurology, particularly professors Jean Lhermitte from France and McDonald Critchley⁷-⁹. Akerman's main contribution to semiology was the description he and his famous mentor Alajouanine published of the Alajouanine–Akerman unstable ataxic hand¹⁰.

THE ALAJOUANINE–AKERMAN UNSTABLE ATAXIC HAND

The Alajouanine-Akerman unstable ataxic hand was described in 1931 in the journal Revue Neurologique in a very important scientific paper titled “Attitude de la main dans une poussée monobrachiale astéréognosique de la sclérose en plaques” (“Attitude of the hand in a monobrachial astereognostic multiple sclerosis attack”)¹⁰. The authors described a case report of a 39-year-old patient with a previous diagnosis of multiple sclerosis who presented with signs and symptoms of sensory ataxia of the right hand along with astereognosis, impaired deep sensation, and pseudoathetosis of the right hand (Fig 2). They discussed the differential diagnosis with thalamic hand and reported that there was a marked improvement in pseudoathetosis after two weeks¹⁰.

Fig 2.
Alajouanine–Akerman unstable ataxic (right) hand.

THE PROFESSOR ABRAHAM AKERMAN LIBRARY

In December 2012, the Professor Abraham Akerman Library was inaugurated in Curitiba, Paraná, in the Neurology Service, Hospital de Clínicas, Federal University of Paraná. The library is a cultural collection containing 1800 books on neurological sciences, many of them being classics of French neurology, including a large number of books from the Charcot school at Salpêtrière and books by leading neurologists from around the world. The library was made possible, thanks to a generous donation by Zeldi Akerman, Professor Akerman's daughter, through the Paciornik family in Curitiba.

CONCLUSION

Professor Abraham Akerman, an eminent twentieth-century Brazilian neurologist, made an important contribution to the progress of neurological sciences in Brazil, notably with the description of a well-known neurological sign, the Alajouanine-Akerman unstable ataxic hand.

References

• ¹
  Teive HAG, Almeida SM, Arruda WO, Sá DS, Werneck LC. Charcot and Brazil. Arq Neuropsiquiatr 2001;59:295-299.
• ²
  Gomes MM. Vultos da história da Neurologia do Rio de Janeiro. In: Reimão R (Ed). História da Neurologia no Brasil. São Paulo: Lemos Editorial; 1999:43-51.
• ³
  Gomes MM. Marcos Históricos da Neurologia. Rio de Janeiro: Editora Científica Nacional; 1997:163-165.
• ⁴
  Gomes MM, Cavalcanti JLS. Fifty years of the Brazilian Academy of Neurology. Arq Neuropsiquiatr 2012;70:956-959.
• ⁵
  Teive HAG, Sá D, Silveira Neto O, Silveira OA, Werneck LC. Professor Antonio Austregésilo. O pioneiro da neurologia e do estudo dos distúrbios do movimento no Brasil. Arq Neuropsiquiatr 1999;57:898-902.
• ⁶
  Goetz CG, Bonduelle M, Gelfand T. Charcot. Constructing Neurology. New York: Oxford University Press; 1995:328.
• ⁷
  Academia de Medicina do Rio de Janeiro. Abraham Akerman. Available at http://www.amrjorg.br/bio_cad91_p.pdf
  » http://www.amrjorg.br/bio_cad91_p.pdf
• ⁸
  Maranhão Filho PA. A mão instável atáxica de Alajouanine-Akerman (1931). In: Maranhão Filho PA (Ed). Autores Brasileiros. Mais de um século de sinais, síndromes e outras contribuições neurológicas e neurocirúrgicas (1878–1998). São Paulo: Editora Omnifarma; 2008:17-19.
• ⁹
  Levy G. Mão instável atáxica de Alajouanine-Akerman. Resgate de um sinal neurológico. Arq Neuropsiquiatr 1999; 57:326-328.
• ¹⁰
  Alajouanine T, Akerman A. Attitude de la main dans une poussée monobrachiale astéréognosique de la sclérose en plaques. Rev Neurol 1931;1:318-322.

Publication Dates

• Publication in this collection
  Sept 2013

History

• Received
  9 Feb 2013
• Received
  23 Apr 2013
• Accepted
  30 Apr 2013