• DOI:10.1007/s10072-015-2191-4
• Corpus ID: 11730078

Has the diagnosis of a stroke been overlooked in the symptoms of Julius Caesar?

@article{Galassi2015HasTD,
  title={Has the diagnosis of a stroke been overlooked in the symptoms of Julius Caesar?},
  author={Francesco Maria Galassi and Hutan Ashrafian},
  journal={Neurological Sciences},
  year={2015},
  volume={36},
  pages={1521-1522}
}

• F. Galassi, H. Ashrafian
• Published 29 March 2015
• Medicine
• Neurological Sciences

Julius Caesar (100–44 BC) is considered one of the greatest military leaders and conquerors of all time. His health status has been the source of a longstanding debate within the historical and medical community who generally suggests epilepsy and Ménière disease as the two prime differentials when considering his morbus comitialis (disease of the assembly hall). To-date, however possible cardiovascular explanations have always been ruled out on the grounds that until his death he was supposedly otherwise physically well during both private and stately affairs. When re-evaluating his symptoms, it can be noted that Caesar suffered falls during his campaigns in Spain and Africa at Cordoba and Thapsus. He reported symptoms of headaches, vertigo and later on mentioned giddiness and insensibility, when he could not stand up as senators honoured him. Together the symptoms of headache, vertigo and falls as a possible result of limb paresis, gait disturbance, sensory deficit or syncopal episode can be considered in terms of cerebrovascular insults and stroke [1, 2]. Furthermore, Caesar also suffered from other symptoms including depression and personality changes (exampled by emotional lability when listening to a moving oration by Cicero), which may also be consistent with cerebrovascular disease [1, 2]. Pliny the Elder reports in his Natural history that both Caesar’s father and another forefather died without any apparent cause whilst putting on their shoes. This has been explained by some in terms of SUDEP (sudden unexpected death in epilepsy); however, these events can be more readily associated with the cardiovascular complications of stroke episode or a lethal myocardial infarction. Even if Caesar participated in an active lifestyle and may have benefited from an environmental background of a Mediterranean diet, there is the added possibility of genetic predisposition towards cardiovascular disease. When assessing other differentials for Caesar’s disease, there is little evidence suggesting Ménière’s disease as no primary source mentions unilateral deafness (unlike Shakespeare). Whilst epilepsy is a possibility, this would have to derive from acquired adult-onset aetiologies (such as head trauma, neurocysticercosis from his Egyptian campaign, arteriosclerosis, syphilis, genetic, malaria, tuberculosis, and glioma) [3]; as there are no clear records of Caesar having suffered seizures in his youth. Furthermore, if Caesar had suffered from epilepsy, his seizures might have been better documented in such a prominent individual [4]. Caesar and his adopted son Octavius may have contributed to the diagnosis of epilepsy, as this was considered a ‘‘sacred disease’’ so that they would have publicised this disorder to better fit with a Caesar’s public profile. In summary, many of the symptoms reported during Caesar’s life are compatible with an underlying diagnosis of cardiovascular disease and repeated cerebrovascular events. Whilst Caesar’s death ultimately derived from his assassination, the possible diagnosis of stroke during his life may offer some novel interpretations regarding several notable incidents during his time as a Roman leader.