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Is Your Brain Really Necessary?


John Lorber, a British neurologist, claims that some
patients are more normal than would be inferred from their brain scans
"Professor John Lorber has a facility drocephalics whose brains are severely that a substantial proportion of patients
for making doctors sit up and think about distorted asymmetrically, the expected appear to escape functional impairment
hallowed concepts," writes Adrian Bow- one-sided paralysis is typically absent? in spite of grossly abnormal brain struc-
er, a neuroanatomist at Sheffield Univer- And how is one to interpret the apparent ture.
sity, England, where Lorber holds a restoration to normality of a hydro- "The spina bifida unit at the Chil-
research chair in pediatrics. "The hu- cephalic brain following a shunt opera- dren's Hospital here in Sheffield is one of
man brain is the current object of his tion? These are the challenges that Lor- the largest in the world," explains Lor-
challenging speculation," continues ber is proffering his neurology col- ber, "and this gives us an opportunity to
Bower, referring to his colleague's re- leagues. make many observations. Since the in-
cent propositions concerning hydroceph- Lorber came to make his observations troduction of the safe, noninvasive brain
alus, or water on the brain. For instance, on hydrocephalus through his in- scanning technique just a few years ago
Lorber was not jesting totally when he volvement with assessment and treat- we have done more than 600 scans on pa-

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addressed a conference of pediatricians ment of spina bifida, a congenital condi- tients with hydrocephalus." Lorber di-
with a paper entitled "Is your brain real- tion in which the spinal column fails to vides the subjects into four categories:
ly necessary?" Lorber believes that his fuse completely, leaving nerve tissue those with minimally enlarged ventri-
observations on a series of hydro- perilously exposed. The great majority cles; those whose ventricles fill 50 to 70
cephalics who have severely reduced of patients with spina bifida also suffer percent of the cranium; those in which
brain tissue throws into question many from hydrocephalus. the ventricles fill between 70 and 90 per-
traditional notions about the brain, both Although the origins of hydrocephalus cent of the intracranial space; and the
in clinical and scientific terms. are to some degree shrouded in mystery, most severe group, in which ventricle ex-
"There's a young student at this uni- it is clearly associated with a disturbance pansion fills 95 percent of the cranium.
versity," says Lorber, "who has an IQ of the circulation of cerebrospinal fluid Many of the individuals in this last
of 126, has gained a first-class honors de- through a system of channels and reser- group, which forms just less than 10 per-
gree in mathematics, and is socially com- voirs, or ventricles, in the brain. Back cent of the total sample, are severely dis-
pletely normal. And yet the boy has vir- pressure apparently develops, and this abled, but half of them have IQ's greater
tually no brain." The student's physician may balloon the ventricles to many times than 100. This group provides some of
at the university noticed that the youth their normal size, so pressing the over- the most dramatic examples of apparent-
had a slightly larger than normal head, lying brain tissue against the cranium. In ly normal function against all odds.
and so referred him to Lorber, simply young children, whose skulls are still Commenting on Lorber's work, Ken-
out of interest. "When we did a brain malleable, one obvious consequence can neth Till, a former neurosurgeon at the
scan on him," Lorber recalls, "we saw be a grossly enlarged head. Additionally, Great Ormond Street Hospital for Sick
that instead of the normal 4.5-centimeter this physical assault from within leads to Children, London, has this to say: "In-
thickness of brain tissue between the a real loss of brain matter. It is therefore terpreting brain scans can be very tricky.
ventricles and the cortical surface, there not surprising that many hydrocephalics There can be a great deal more brain tis-
was just a thin layer of mantle measuring suffer intellectual and physical dis- sue in the cranium than is immediately
a millimeter or so. His cranium is filled abilities. What is surprising, however, is apparent." Till echoes the cautions of
mainly with cerebrospinal fluid." many practitioners when he says, "Lor-
This is dramatic by any standards, and ber may be being rather overdramatic
Lorber clearly enjoys retailing the story. when he says that someone has 'virtually
But, startling as it may seem, this case is no brain.' " Lorber acknowledges the
nothing new to the medical world. problem of.interpretation of brain scans,
"Scores of similar accounts litter the and he counters Till's remarks by insist-
medical literature, and they go back a ing, "Of course these results are dramat-
long way," observes Patrick Wall, pro- ic, but they're not overdramatic. One
fessor of anatomy at University College, would not make the claim if one did not
London, "but the important thing about have the evidence."
Lorber is that he's done a long series of Third A major obstacle in this work is the
systematic scanning, rather than just difficulty of obtaining the kind of quan-
dealing with anecdotes. He has gathered Cerebral ventricles titative data that would be expected in a
a remarkable set of data and he challeng- Two hornlike lateral ventricles drain into a
scientific investigation of, say, rat
es, 'How do we explain it?' " common third ventricle which in its turn leads brains. "I can't say whether the mathe-
How can someone with a grossly re- to a common fourth ventricle. Cerebrospinal matics student has a brain weighing 50
duced cerebral mantle not only move fluidflows from the lateral ventricles, through grams or 150 grams, but it's clear that it
the third and fourth ventricles, leading to a
among his fellows with no apparent so- "sink" along the midline at the top of the is nowhere near the normal 1.5 kilo-
cial deficit, but also reach high academic head and to a channel that runs down the grams," asserts Lorber, "and much of
achievement? How is it that in some hy- spinal column. the brain he does have is in the more
1232 0036-8075/80/1212-1232$00.50/0 Copyright X 1980 AAAS SCIENCE, VOL. 210, 12 DECEMBER 1980
primitve deep structures that are rela-
tively spared in hydrocephalus."
Lbrber concludes from these observa-
-tions that "there must be a tremendous
amount of redundancy or spare capacity
in the brain, just as there is with kidney
and liver." He also contends that "the
cortex probably is responsible for a great
deal less than most people imagine."
These are two areas of considerable dis-
pute in neurobiology. Wall lends support
for this second point. "One reason why
results such as Lorber's have been ne-
glected for so long is because of the im-
plied attack on the predominance of the
cerebral cortex," suggests Wall. "For Scans of normal and hydrocephalic brains
hundreds of years neurologists have as- A horizontal scan across the brain shows the ventricles as narrow slits in a normal individual
sumed that all that is dear to them is per- and large cavities in a hydrocephalic patient.
formed by the cortex, but it may well be
that the deep structures in the brain car- functional disruption, but if the same the condition in cats. The group also ob-
ry out many of the functions assumed to damage is done bit by bit over a long pe- served the changes in tissue structure
be the sole province of the cortex." He riod of time, the dysfunction can be mini-following the implantation of a shunt, the

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likens the cortex to a "reference library" mal. Just as the rat brains appear to copeexperimental equivalent to the normal
that may be consulted from time to time. with a stepwise reduction of available treatment of hydrocephalus in humans.
Norman Geschwind, a neurologist at hardware, so too do the human brains in Speaking for the group, Fred Epstein
the Beth Israel Hospital, Boston, strikes some cases of hydrocephalus. says the following: "Hydrocephalus is
a different note. "Deep structures in the Another subgroup of some curiosity in principally a disease of the white matter.
brain are undoubtedly important for Lorber's subjects are those people in As the ventricles enlarge the layers of fi-
many functions," he agrees, "but I don't whom expansion of the ventricles is re- bers above them begin to be stretched
believe the explanation that the cortex stricted to just one side of the brain. "I've
and very quickly they are disrupted, with
does far less than we think is very now seen more than 50 cases of asym- the axons and the myelin sheaths sur-
sound." And neither does David Bow- metric hydrocephalus," says Lorber, rounding them breaking down. Even in
sher, professor of neurophysiology at "and the interesting thing is that only a severe and extended hydrocephalus,
Liverpool University, England: "I don't minority of these individuals show the however, the nerve cells in the gray mat-
think we attribute more to the cortex expected and long-cherished neurologi- ter were remarkably spared, though
than it deserves." Bower, however, cal finding of paralysis with spasticity on
eventually there began to be a loss here
takes the middle ground, with the sug- the opposite side of the body." To make too." The sparing of the gray matter
gestion that "the deep structures are al- matters even more puzzling, one individ- even in severe hydrocephalus could go
most certainly more important than is ual in the group has enormously enlarged some way to explaining the remarkable
currently thought." ventricles on the same side as his spasticretention of many normal functions in se-
On the question of the brain's spare paralysis. "This is exactly the opposite verely affected individuals.
capacity there is equal contention. "To to all that we learnt in medical school," Crucial to the approach to treatment of
talk of redundancy in the brain is an in- reports Lorber with obvious glee. These hydrocephalus is the brain's ability to re-
tellectual cop-out to try to get round observations are cogent support for cuperate following the release of fluid
something you don't understand," states Bower's comment that "the concept of pressure when a shunt is implanted. One
Wall. Geschwind agrees: "Certainly the contralateral control is the least secure of the canons of neurobiology is that,
brain has a remarkable capacity for reas- of all our concepts about brain organiza- once damaged, cells in the central ner-
signing functions following trauma, but tion and function." vous system are unable to repair them-
you can usually pick up some kind of Lorber's extensive series of brain selves. Does Lorber's work dent this
deficit with the right tests, even after ap- scans stands in marked contrast with the hallowed concept too? "When you im-
parently full recovery." However, Colin dearth of information on the fine struc- plant a shunt in a young hydrocephalic
Blakemore, professor of physiology at ture of hydrocephalic human brains. "It child you often see complete restoration
Oxford University, England, sees spare is crucial to know about the histological of overall brain structure, even in cases
capacity as an important quality of the state of the brains of these functionally where initially there is no detectable
human brain. "The brain frequently has normal hydrocephalic patients," re- mantle," claims Lorber. "There must
to cope with minor lesions and it's cru- marks Lorber, "but how am I to have ac- be true regeneration of brain substance
cial that it can overcome these readily," cess to such material, given the ethical in some sense, but I'm not necessarily
he says; "there may be some reorganiza- barriers to scientific research on pa- saying that nerve cells regenerate," he
tion of brain tissue, but mostly there's a tients?" Inadequate though it is, the nextsays cautiously; "I don't think anyone
reallocation of function." best thing is experimental work on ani- knows fully about that."
It is perhaps significant that many of mals. What, then, is happening when a hy-
the instances in which gross enlargement A group of researchers based at the drocephalic brain rebounds from being a
of cerebral ventricles is compatible with New York University Medical Center thin layer lining a fluid-filled cranium to
normal life are cases where the condition has assembled a picture of the histologi- become an apparently normal structure
develops slowly. Gross surgical lesions cal changes associated with hydrocepha- when released from hydrostatic pres-
in rat brains are known to inflict severe lus through experimental induction of sure? According to Epstein and on the
12 DECEMBER 1980 1233
basis of his colleagues' observations on pendent on surgical care, and in any case certain amount of value." Thoma~Mil-
experimental cats,- the term rebound apt- many of these subjects can lead perfectly horat, a neurosurgeon at the Children's
ly describes the reconstitution process, normal lives." The difference is between Hospital in Washington, D.C., voikes
with stretched fibers shortening, thus di- the acute and chronic conditions. strong support for Lorber, in spite of
minishing the previously expanded ven- These statements are certain not to go many differences of opinion. "I'm glad
tricular space. Within a short time scar unchallenged, partly because there is a there's a John Lorber," says Milhorat;
tissue forms, constructed from the glial multiplicity of opinions about appropri- "he could be more moderate in the way
cells that pack between the nerve cells. ate treatment of hydrocephalus and part- he expresses things, but a moderate view
"The reconstitution of the mantle," re- ly because it is Lorber who is making would not emerge if someone were not
port Epstein and his colleagues, "does them. Lorber is no stranger to controver- speaking out strongly."
not result in the reformation of lost ele- sy. Just a few years ago he caused a As to the question "Is your brain real-
ments, but rather in the formation of a storm in the medical world by suggesting ly necessary?" Lorber admits that it is
glial scar and possibly a return to func- that it is not always medically right to ad- only half serious. "You have to be dra-
tion of the remaining elements." minister extensive treatment to some in- matic in order to make people listen,"
Lorber claims that his observations on fants with spina bifida. His experience concedes the tactician. Bower's answer
the dramatic recovery of severely af- had taught him that the consequences in to the tongue-in-cheek question is this:
fected young children imply that "clini- some severe cases were simply not toler- "Although Lorber's work doesn't dem-
cians shouldn't give up in the face of an able, either to the patient or to the imme- onstrate that we don't need a brain, it
apparently hopeless case; a shunt opera- diate family. This position continues to does show that the brain can work in
tion at an early stage has a good chance be hotly debated, but Lorber's ideas are conditions we would have thought im-
of producing a normal individual." In beginning to receive favorable consid- possible." Bower occasionally com-
mild cases, or ones that develop slowly eration, particularly in the United King- plains that Lorber's style is less scien-

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and late, Lorber takes a different ap- dom (see 12 September 1980, p. 1216). tific than it might be. He concedes, how-
proach. Citing the example of the mathe- What of the Lorber approach to hy- ever, that "there are still many questions
matics student and others like him, he drocephalus? "His attitude is based on to be answered about the human brain,
proposes that perhaps the surgical knife many years of clinical experience," says and it has to be admitted that Lorber's
should be stayed, "because a shunt op- Gerald Hochwald of New York Univer- provocative approach does make you
eration makes an individual forever de- sity Medical Center, "and it contains a think about them."-ROGER LEWIN

Math and Sex: Are Girls Born with Less Ability?


A Johns Hopkins group says "probably. " Others are not so sure
Throughout history there have been dence that extraordinary mathematical cuss their data on page 1262 of this issue.)
very few women mathematicians, and talent may be less prevalent in girls than Stanley contends that the math SAT
this trend continues today. For example, in boys. The differences between the serves as an aptitude test when given to
when Edith Luchins, a mathematician at abilities of girls and boys are so striking, 7th and 8th graders because they have
Rensselaer Polytechnic Institute, and they say, that it is hard to imagine that not been formally taught the principles
Abraham Luchins, a psychologist at the they are entirely due to socialization. By that underlie the math problems. If they
State University of New York at Albany, sticking their necks out in this way, Ben- can do the problems, they must have un-
asked mathematicians to list five famous bow and Stanley seem to be asking for an usual abilities.
contemporary women mathematicians, attack. But, says Stanley, "We want our In 1980, the Johns Hopkins group ex-
many could not. When Ravenna Helson, data out in the public domain so they panded its talent search and changed its
a psychologist at the University of Cali- can't be ignored." eligibility criteria. Any 7th grader who
fornia at Berkeley, set out in the 1960's The data are from Stanley's mathe- scored in the 97th percentile or above in
to study creative women mathemati- matics talent searches, the Study of any standardized achievement test-
cians, she reported that there were so Mathematically Precocious Youth. From whether the high score was in a math
few that she did not have to sample 1972 to 1979, Stanley and his associates section or a verbal section or was a com-
them-she could study all of them. conducted six talent searches, looking bined score-was invited to take the ver-
Since creativity in mathematics seems for 7th and 8th graders who scored in at bal and math SAT's. The researchers
to be a talent, like musical or artistic abil- least the upper 2 to 5 percent in standard- found 10,000 such students, making the
ity, the question has been, why are there ized mathematics achievement tests, total tested thus far 20,000.
so few outstanding women mathemati- such as the Iowa Tests of Basic Skills. Every year, the Johns Hopkins group
cians? Some researchers have said the They found 10,000 children, 43 percent has found that the girls and boys do
answer lies in nurture rather than nature. of whom were girls, and invited them to equally well on the verbal SAT's but the
Mathematics is viewed as a "masculine" take the mathematics and verbal por- boys do significantly better on the math
field of study, and girls are discouraged tions of the Scholastic Aptitude Tests SAT's. For example, more than twice as
from developing their mathematical abil- (SAT). Those who did extremely well on many boys as girls had math scores
ities. But Camilla Benbow and Julian the math portion were encouraged to greater than 500. The greatest dif-
Stanley of Johns Hopkins University take accelerated mathematics courses at ferences were between the top-scoring
question this theory. They have evi- Johns Hopkins. (Benbow and Stanley dis- girls and boys. And in every talent
1234 0036-8075/80/1212-1234$00.50/0 Copyright 0 1980 AAAS SCIENCE, VOL. 210, 12 DECEMBER 1980