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Organists and organ music composers C. Foerch*, Michael G. Hennerici†,1 *Department of Neurology, Goethe-University, Frankfurt am Main, Germany Department of Neurology, Universita¨tsmedizin Mannheim, University of Heidelberg, Mannheim, Germany 1 Corresponding author: Tel.: +49 621/383-2885; Fax: +49 621/383-380, e-mail address: [email protected]
†
Abstract Clinical case reports of patients with exceptional musical talent and education provide clues as to how the brain processes musical ability and aptitude. In this chapter, selected examples from famous and unknown organ players/composers are presented to demonstrate the complexity of modified musical performances as well as the capacities of the brain to preserve artistic abilities: both authors are active organists and academic neurologists with strong clinical experience, practice, and knowledge about the challenges to play such an outstanding instrument and share their interest to explore potentially instrument-related phenomena of brain modulation in specific transient or permanent impairments. We concentrate on the sites of lesions, suggested pathophysiology, separate positive (e.g., seizures, visual or auditory hallucinations, or synesthesia [an involuntary perception produced by stimulation of another sense]) and negative phenomena (e.g., amusia, aphasia, neglect, or sensory-motor deficits) and particularly address aspects of recent concepts of temporary and permanent network disorders.
Keywords organist, composer, music, neurology, disease, seizure, stroke
1 INTRODUCTION Of all mental faculties, music shows the clearest signs of nonverbal communication— in all cultures and from unknown centuries until today mankind have enjoyed music. Singing and instrument playing are also among the oldest systems of communication either involved into speech or itself as a special form of speech. While performance and reception of music depend on sensory-motor capacities and education, cognitive functions and creativity are independent from musical perception but can focus on separate specific abilities, ranging from tone deafness and amusia to musical genius independently of other measures of intelligence including language. Progress in Brain Research, ISSN 0079-6123, http://dx.doi.org/10.1016/bs.pbr.2014.11.032 © 2015 Elsevier B.V. All rights reserved.
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Clinical case reports of patients with musical dysfunction provide clues as to how the brain processes musical ability and aptitude: from clinical investigation and psychological testing of normal, educated, or professional musicians to different stages of sedation or brain damage, the mosaic illustrates the complexity of the brain network, which is far from understood: even in times of functional brain-imaging studies, illustrating sites and timing of musical paradigms during imagination and performance in genius, healthy, aging, and diseased, or demented people. This chapter is written by two neurologists and active organists, who have passed a separate musical education in parallel to their medical training and performed organ playing in church services as well as concert performances. However, both are scientific academic neurologists with strong experience in clinical neurology and for years have studied with particular interest in disorders of musical capacities in their patients suffering from various diseases: from onset of symptoms to recovery, may they be partial or even full with physical and mental independence eventually. We have also been interested in the search of illustrative examples of neurological problems as reported from professional, famous artists (and organ players/composers in particular), some of them are listed in the following text: according to traditional neurological investigations, we will concentrate on the sites of lesions and suggested pathophysiology, separate positive (e.g., seizures, visual or auditory hallucinations, or synesthesia [an involuntary perception produced by stimulation of another sense]) and negative phenomena (e.g., amusia, aphasia, neglect, or sensory-motor deficits) and particularly address aspects of the more recent concept of temporary and permanent network disorders and cortico-subcortical circuit dysfunction (e.g., very common in patients with subcortical vascular encephalopathy and vascular dementia from small vessel disease in chronic atherosclerosis). In the future, probably the most challenging tasks for neuroscientists and clinicians will be to better understand the mechanisms of continuous repair or reset of brain programs for healthy aging: a provocative look at how new research is highlighting the emerging powers of the aging mind was formulated in the Wisdom Paradox by the world-renowned neuropsychologist Elkhonon Goldberg (2006): he argued that though mental abilities (such as recent memory recall) decline as the mind enters the “autumn season” of our life span, the brain becomes more powerful in its ability to recognize specific patterns. Preserved or regained musical communication abilities may be of particular interest and importance once old healthy individuals make decisions at more intuitive levels—a late-emerging mental strength Goldberg termed “wisdom.”
2 CLASSICAL AND CHURCH ORGANISTS AND ORGAN MUSIC COMPOSERS The majority of organists, both amateur and professional, are basically involved in church music, where the pipe organ plays the leading role in traditional Christian worship. Depending on the churches, culture, denomination, local settings, and
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standards of the organists, a wide variability of musical pieces can be produced: different from any other instrument, even if a full romantic orchestra is considered—by one person only playing on up to six keyboards plus pedal with his hands and feet, the same composition with uncountable numbers of different colors and impressions. Beyond other musical instruments, most of the literature composed for organ have been written by organists themselves, and many of them have been excellent in spontaneous improvisation: Johann Sebastian Bach, Dietrich Buxtehude, Felix Mendelssohn, Franz Liszt, Ce´sar Franck, Camille Saint-Saens, Charles Marie Widor, Marcel Dupre, Maurice Durufle, etc. The organ (from Greek organon ¼ instrument) is a keyboard instrument of one or more divisions, each played either with the hands or with the feet. In the Western musical tradition, it dates back from the time of Alexandria. It was introduced in the church worship only during the fifteenth and sixteenth centuries in Europe. Since then pipe organs have used various materials for pipes that cover wide tonal volumes. They are divided into separate or mixed pipe ranks and controlled by the use of hand stops and/or combination pistons. Although the keyboard is less impulsive as on a piano, dynamics are to be controlled by the different mechanical/electronic structures of the instrument and dynamics originally designed by the organ builder. All instruments vary in size and sound characteristics; they are unique like artists’ paintings in churches, synagogues, and concert halls or even homes. The pipe organ existed in its current form since the fourteenth century and was considered to be the most complex human-made mechanical creation before the Industrial Revolution. The biggest instruments have 64 ft pipes and have sounds down to an 8 Hz frequency fundamental tone, nearly unrecognized even by young human beings. Perhaps, its most distinctive feature is the ability to range from the slightest sound to the most powerful discharge comparable with huge romantic symphony orchestras. In the nineteenth and twentieth centuries, organ music became more and more independent from church services, and in particular in French-speaking countries, organ recitals even replaced symphony orchestras by playing transcriptions of orchestral pieces (Edward Elgar, Charles Marie Widor, and Ce´sar Franck). Similar to the human voice-related antiphonal music of the late Middle Ages and the Renaissance period (Jan Petersen Sweelinck and Girolamo Frescobaldi) with its breath-related spontaneous rhythm modulations, more recent organ music of the twentieth century tended to concentrate on less dramatic effects and even mirrors human and animal singing as recorded from nature (Olivier Messiaen, Jean Alain, etc.).
3 NEUROLOGICAL FINDINGS 3.1 POSITIVE PHENOMENA It is well known that so-called musicogenic seizures are triggered by listening to music—and the trigger might be quite specific (e.g., classical or popular music, a particular piece or a special motif, sometimes existing of a few tones only such as
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in Beethoven’s Symphony No. 5 or Big Ben’s Church Hall Melody). Sometimes even the imagination or reading of the written notes can trigger seizures. Partial seizures may present as musical hallucinations, similarly set up by various stimuli and supposed to originate from the superior temporal gyrus of either hemisphere—they can consist of verbal or nonverbal phenomena and may be associated with impaired vision (e.g., Charles–Bonnet Syndrome). Sutherling et al. (1980) reported a 67-year-old organist with diabetes, who suffered from stereotyped focal seizures of the left lower face, jaw, and neck while playing a certain hymn (Now thank we all our God) on the organ. In contrast, seizures were not induced by reading, singing, or hearing the hymn or by playing the hymn silently (pushed hand stops). If the patient was asked to play this specific hymn on three successive occasions, this was followed by the same partial seizures irrespective of the stop settings; however, if he played another hymn with the same keys, stops, and time sequence, there was no seizure, although this hymn shared some chords with the qualifying one. Interestingly, when he was asked to imitate playing of the inciting hymn by making the appropriate finger movements in the air, this was followed by a seizure. Singing the hymn aloud or in his mind or listening to someone singing or to two other organists playing the hymn, all failed to induce a seizure. This shows that the complexity and specificity of reflex seizures to a musical stimulus are much more difficult to understand than one might have suggested—it obviously mirrors failures or compensates mistakes in a substantially complex interactive network. Similar observations are reported by patients playing music on the piano as well—the unique appearance of this patient was that he had to play this specific composition himself on the organ or at least making the appropriate movements of this particular sequence of notes himself: the different results of silent playing and imitation remain obscure. Unfortunately, brain-imaging studies were not performed in those days. Wieser and Walter (1997) published another case of an organist who during an organ concert had suffered a complex partial seizure. The concert was recorded and analyzed in detail: while the left hand in the beginning of the seizure became imprecise, the right hand remained faultless—with increasing duration, the dissociation of both hands increased but the right hand succeeded in parts compensating for the errors of the left hand in a musically meaningful way. The authors propose that the case illustrates “untroubled musical judgment during epileptic activity of the right temporal lobe” and speculated about “the ability of improvisation in the sense of a perfect musical solution to errors of the left hand.” The patient underwent epilepsy surgery later that gave strong evidence about the origin of the seizures from the right hippocampal formation. Examples of the original score of the piece by John Stanley (1713–1786) and the variation as played by the patient are given in Figs. 1 and 2. Synesthesia is a condition in which stimulation of one sensory modality causes unusual experiences in a second, unstimulated one, i.e., sound produced the perception of colors and vice versa. Hubbard and Ramachandran (2005) reviewed the literature with emphasis on neural cognitive mechanisms suspected to be responsible for synesthesia and Mulvenna (2007) discussed synesthesia in the arts and creativity. Synesthetes do not report their experiences to a physician usually, different from
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FIGURE 1 Original composition Voluntary VIII opus 5 for organ by John Stanley (1713–1786) bars 20–22 (A) and variations as played by the patient (B). Courtesy of Elsevier Publishers from reference 2; (Wieser and Walter, 1997).
FIGURE 2 Musical analysis of seizure-induced variations, beginning with an error of the left hand in the middle of bar 20. (As indicated by arrow and circled numbers; detailed analysis in reference 2; Wieser and Walter, 1997.) Courtesy of Elsevier Publishers.
other episodes like epilepsy, migraine, Charles–Bonnet Syndrome, etc. Used to the complex series of specific moving colors and shapes, induced by an entire musical piece, that will be reproduced unchanged every time, the synesthete hears that piece played with the same instruments. It is recognized as a neurological phenomenon, whether or not it plays an active role or might even be necessary for successful creative output is unknown. However, studies have shown that synesthetic people have higher abilities in creative cognition. The French composer of harmony at the Paris Conservatoire, organist at l´ Eglise de la Sainte-Trinite´ in Paris and ornithologist Olivier Messiaen (1908–1992)— whether a “true synesthete” or not—very precisely reported what he experienced:
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“Colors are very important to me because I have a gift—it’s not my fault, it’s just how I am—whenever I hear music or even if I read music, I see colors.” He claimed peculiarities like the lower range of C-Sharp was “copper with gold highlights,” D-flat was “orange with stripes of pale yellow, red and gold” (if he was a true synesthete, the sound of D-flat would never change from orange and yellow to green or blue). Olivier Messiaen was born in 1908 in Avignon, educated at the Convervatoire Nationale Supe´rieur de Musique et de Danse de Paris from 1919 to 1930 and played an important role in modern East and West European music. Because of his enormous abilities in improvisation, he became a member of the master class of Marcel Dupre´ (1886–1971), who was titular organist at St. Sulpice in Paris and professor of organ performance and improvisation at the Paris Conservatoire. When Oliver Messiaen was 11 years old, he visited the Sainte Chapelle and was overwhelmed by the colors of the stained glass windows: “It is true, I see colors, it is true, they are there— however, as a musician I see musicians’ colors, not to be confused with painters’ colors. They are colors that go with music. If you try to reproduce these colors on canvas, it may produce something horrible. They are not meant for that.” Since the age of 18, Oliver Messiaen has been collecting the songs of thousands of birds throughout France and the world. He found birdsongs fascinating and incorporated transcriptions into his music with very specific rhythm annotations and sound-requests if available in the individual instruments. His innovative use of colors, specific relationships between time and music as well as ancient and exotic rhythms, and his use of birdsongs make his composition distinctive and unique (L´ascension, La Nativite´ du Seigneur, Les corps glorieux) (Fig. 3). Messiaen was inspired by the mystical, natural, and Roman Catholic faith and so was his music.
3.2 NEGATIVE PHENOMENA Negative phenomena without focal lesions are rare not only in organists, but also in clinical neurology. In particular, the interference of transient memory deficits with daily activity and especially musical performance has only recently been investigated in more detail and is still only partially understood: we found a report by Byer and Crowley (1980) about an organist who suffered an episode of transient global amnesia (TGA) during a recital. Despite immediate short-term memory deficits, he continued playing his part of complex organ music to some extent without any recognition in his behavior during the episode: other people can drive a car without making mistakes, register in a hotel, go asleep, and only once they awake the next day, they cannot remember the way it took them and where they found a parking place for their car or how they managed to arrive in this place. The remarkable preservation to conduct, compose, perform, or recognize music in this situation can be explained by small lesions found on magnetic resonance imaging in the hippocampus of these patients, which is a major brain area associated with short-term memory function. Byer and Crowley reported a 66-year-old retired professor of music who was healthy until the night of an organ recital. Like the majority of people suffering
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FIGURE 3 Olivier Messiaen a page from “Oiseaux exotiques” (1955). It illustrates Messiaen’s use of ancient and exotic rhythms (in the percussion near the bottom of the score: “Asclepiad” and “Sapphic” are ancient Greek rhythms, and Nibc¸ankalıˆla is a decıˆ-t^ala from S´a¯rn˙gadeva). It also illustrates Messiaen’s precision in notating birdsongs: the birds identified here are the white-crested laughing thrush (garralaxe a` huppe blanche) in the brass and wind instruments, and the orchard oriole (troupiale des vergers) played on the xylophone. Courtesy of Glarean Magazin 2007.
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with TGA episodes, he was under increased emotional stress during the week prior to the recital. He played the four manual 56-rank organ, which was located at the back of the church while his wife, with whom he performed the duets, was seated at another organ in the front of the church. Because of the distance between the two instruments, timing was difficult anyhow. The first three pieces were familiar to him—although after the episode he did not remember them. During the following concerto by G. F. Ha¨ndel, he failed to change the organ registration and stopped midway in the Andante, changed the registration, and repeated the first 16 measures which his wife realized as “uncharacteristic of him.” In the next Symphonia Festiva by Near, he again failed to change the registration, but played as written. At this point, he had to leave the back of the church and proceed to the front where he was supposed to perform on the harpsichord, which he did not. His wife realized that something was wrong, played the solo herself while he returned to the organ loft at the back of the church. After the concert, he greeted the people, but failed to recall some names of his friends and behaved very strangely: like all patients with TGAs, he typically repeated the same question several times (What day is it? Is it Sunday?) again and again although the answers were given repeatedly. TGA episodes were first described by Fisher and Adams (1958) already in the late 1950s, and clinical diagnosis was easy if considered appropriately. The pathogenesis, however, remained uncertain, and the brain structures involved could not be identified. Today more than 80% of our patients present with characteristic DWI-MR spots in either one or both hippocampi 24–48 h after onset of symptoms (Sedlaczek et al., 2004). It is unlikely that the episode in this organist has anything to do with a specific pattern of musical understanding or performance, but reflects the inability of short memory during or after severe emotional stress in most patients with TGAs: like an unexpected computer breakdown is associated with lack of storage of all material presented, perfect function follows the episode with very low frequency of recurrent episodes. Negative phenomena in the presence of focal lesions are common findings in neurological diseases, however, in combination with musical experiences they are quite rare. However, the available literature points toward a special dissemination of speech and music in the brain. Most remarkable is the case of the famous French organist Jean Langlais (1907–1991), who suffered an embolic infarction in the left middle cerebral artery territory, involving the temporal and the inferior parietal lobes. Details of his medical record including a reprint of the CT scan depicting the infarction have been published in a pseudo-anonymous fashion in French language (Signoret et al., 1987). Later on, it was proclaimed that the patient indeed was Jean Langlais, leading to an update article on what happened at that time in English language (Fisher and Larner, 2008). Since the age of 2 years, Langlais was blind, likely due to a congenital glaucoma with eye infection. At the Institut National des Jeunes Aveugles (National Institute for Blind Children) in Paris, he was taught using braille. Later on, he used the same braille—depending on the context—to read and write language as well as music. Following his studies at the Paris Conservatoire, he was announced organiste titulaire at the Basilica of Sainte-Clotilde in Paris, a
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position he hold for more than 40 years. His music is barely tonal, his themes are often based on simple liturgical chants, e.g., the “incantation pour un jour saint” with its ascending “Lumen Christi” acclamations. Langlais’ stroke occurred while playing in a church service. Initially, the right-handed patient suffered from a right-sided hemiparesis that resolved quickly. Persistent, however, was a severe Wernicke aphasia with jargon aphasia, anomia, difficulties in repetition, and a comprehension deficit. He was not able to read and write in braille any more. On the other side, amusia was not present at all. Langlais was still able to play organ—both according to scores and improvisation. He still read and wrote music, and even composed organ pieces after his stroke. His aphasia persisted within the following months, again indicating that the stroke was severe enough to destruct functional areas in the primary speech areas of the brain. The authors concluded that the description of a stroke in a highly talented musician implicates a dissociation of language and music. In particular, the use of braille in which the same constellation of dots corresponds to either letters of the alphabet or musical notes, supports this hypothesis. The right hemisphere may play a key role in music. This hypothesis is also supported by a rather anecdotal case report of a lay organist that was published by McFarland and Fortin (1982). He was not able to read and write music throughout his life, but he was able to play familial melodies on his organ. At the age of 78 years, he suffered an embolic stroke in the right temporoparietal region (closely related to the Sylvian fissure) that involved the superior temporal and supramarginal gyri, too. Later on, the patient had only slight difficulties recognizing familiar melodies and had no significant motor deficits at all. However, he was not able to play the melodies on the organ any more. This case report again suggested that the right hemisphere might be critically involved in executing music.
3.3 VASCULAR EVENTS In his collection of historical miniatures entitled “Sternstunden der Menschheit” (English translation entitled “Decisive Moments in History”), the Austrian writer Stefan Zweig perceptively describes Georg Friedrich Ha¨ndel’s “resurrection” from the physical impairment and the mental sequelae that hampered him after having suffered a stroke (Zweig, 1964). The miniature starts with a scene at Ha¨ndel’s apartment in London in 1737, right at the time when he developed first symptoms of his stroke. According to Zweig, Ha¨ndel had a right-sided hemiparesis that forced him to immediately quit all musical activities. Following a long period of rehabilitation, he returned to London several months later without any apparent disability. However, while trying to resume composing, he felt weary, lethargic, and depressed. Almost resigned, he returned home one night and detected a new libretto on his writing desk. After having opened the cover, he was able to read the first sentences: “Comfort ye my people”—words that later on will become the opening section of one of Ha¨ndel’s most famous works, the Messiah. These words transformed Ha¨ndel’s mood instantly. With unprecedented creativity, he completed his masterpiece within a few weeks, with minimal sleep and food consumption.
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A less anecdotal and more scientific evaluation of Ha¨ndel’s cerebrovascular disease was published by Ba¨zner and Hennerici (2004). Ha¨ndel, born in 1685 in Halle an der Saale, had a positive family history for cerebrovascular diseases. Most likely he accumulated several vascular risk factors, such as arterial hypertension, smoking, and alcohol consumption. Ha¨ndel suffered his first stroke (the one mentioned in Zweig’s novel) in 1737. Historical documents and early biographies described a paresis of the right extremities, one source even specified that the “palsy took entirely away the use of 4 fingers of his right hand.” In addition, “mental confusion” (probably aphasia) was apparently also a symptom of Ha¨ndel’s stroke. After a long-lasting rehabilitation treatment in the thermal bath Aachen, Ha¨ndel returned to London under the broad attention of the public. He was free of any functional disability and resumed composing and performing music. In 1743 and 1745, some “recurrence of his paralytic disorder” was reported in the historical literature. Apparently, all strokes provoked motor deficits exclusively of the right-sided extremities. The latter strokes most likely did not cause long-lasting symptoms. In 1751, an acute loss of visual acuity did occur in his left eye while composing his oratorio “Jephtha.” Ha¨ndel noted in the score sheet: “Biss hierher komen den 13. Febr. 1751 verhindert worden wegen relaxation des gesichts meines linken auges” (got as far as this on 13th February 1751, unable to go on owing to weakening of the sight in my left eye). Ha¨ndel’s visual disturbance recovered steadily, but worsened again in the following months. From 1753 onward, Ha¨ndel was not able to hand-write his compositions any more, but dictated them. After ophthalmologists made the diagnosis of a cataract, Ha¨ndel underwent several eye operations. All of them were not able to recover his debility of sight. In the article, Ba¨zner and Hennerici suggested potential etiologies for Ha¨ndel’s strokes. Based on the matter of fact that Ha¨ndel suffered three strokes with no longlasting functional residues, leaving him still able to compose masterpieces, lacunar infarctions due to cerebral microangiopathy appears to be a plausible hypothesis. Lacunar strokes have a rather good prognosis and typically do not involve cortical structures. The reported “speech disturbances” may then be interpreted as a “dysarthria clumsy hand syndrome.” On the other side, a severe atherosclerotic carotid stenosis on the left side may have caused several left hemispheric embolic strokes. The above mentioned precise description that “4 fingers” of Ha¨ndel’s right hand were affected, may well lead to the assumption that the cortical hand knob was involved. Although the visual acuity loss was sudden, painless, and monocular, it was longer than a typical amaurosis fugax (which lasts for minutes typically). The authors therefore suggested an ischemic opticus neuropathy, which also can be found frequently in patients with an ipsilateral high-grade carotid stenosis. Ha¨ndel died in 1759 in London and was buried in Westminster Abbey. Recently, Foerch et al. (2012) enlightened the remarkable death of the great French organist and composer Louis Vierne (1870–1937). From early childhood days on, Vierne suffered from severe visual impairment (likely due to a congenital cataract), but was at least able to read text written in large-scale letters. His extraordinary talent in music was refined and shaped by the best organists in Paris, namely Cesar Franck and Charles Marie Widor. For many years, Vierne was the principal
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organist at the cathedral of Notre Dame de Paris. Vierne died probably the most “beautiful” death an organist could imagine. He deceased right at his beloved organ console at the “Notre Dame” cathedral in Paris while playing an organ concert. Eye witnesses reported that Vierne was in the midst of performing his “Matinee,” a calm and meditative three-movement piece for organ solo, when suddenly his hands started to cramp. Shortly thereafter, Vierne lost his consciousness and slid down from the organ bench with his left foot pushing down the low e pedal. This single tone echoed through the cathedral for a while. Most of the respective literature on this incident considered a stroke as being the most likely cause of Vierne’s death. However, a critical revision from a medical perspective taking into account the preceding shortness of breath, the sudden death, and the lack of focal neurological signs or headache led to the conclusion that a primary cardiac event is more likely to assume.
REFERENCES Ba¨zner, H., Hennerici, M.G., 2004. Georg Friedrich Ha¨ndel’s strokes. Cerebrovasc. Dis. 17, 326–331. Byer, J.A., Crowley Jr., W.J., 1980. Musical performance during transient global amnesia. Neurology 30, 80–82. Fisher, C.M., Adams, R.D., 1958. Transient global amnesia. Trans. Am. Neurol. Assoc. 83, 143. Fisher, C.A.H., Larner, A.J., 2008. Jean Langlais (1907–1991): an historical case of a blind organist with stroke-induced aphasia and Braille alexia but without amusia. J. Med. Biogr. 16, 232–234. Foerch, C., Lemercier, S., Hennerici, M.G., 2012. A beautiful stroke? A side note on the 75th anniversary of the spectacular death of the French organist and composer Louis Vierne (1870–1937). Cerebrovasc. Dis. 34, 322–325. Goldberg, E., 2006. The Wisdom Paradox. Gotham Books, New York. Hubbard, E.M., Ramachandran, V.S., 2005. Neurocognitive mechanisms of synesthesia. Neuron 48, 509–520. McFarland, R., Fortin, D., 1982. Amusia due to right temporoparietal infarct. Arch. Neurol. 39, 725–727. Mulvenna, C.M., 2007. Synaethesia, the arts and creativity: a neurological connection. In: Bogousslavsky, J., Hennerici, M.G. (Eds.), Neurological Disorders in Famous Artists. Part 2. Frontiers of Neurology and Neurosciences, vol. 22. Karger Publishers, Basel, pp. 206–222. Sedlaczek, O., Hirsch, J.G., Grips, E., Peters, C.N., Gass, A., W€ ohrle, J., Hennerici, M., 2004. Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia. Neurology 62, 2165–2170. Signoret, J.L., van Eeckhout, P.H., Poncet, M., Castaigne, P., 1987. Aphasie sans amusie chez un organiste aveugle. Rev. Neurol. (Paris) 143, 172–181. Sutherling, W.W., Hershman, L.M., Miller, J.Q., Lee, S.I., 1980. Seizures induced by playing music. Neurology 30, 1001–1004. Wieser, H.G., Walter, R., 1997. Untroubled musical judgement of a performing organist during early epileptic seizure of the right temporal lobe. Neuropsychologia 35, 45–51. Zweig, S., 1964. Sternstunden der Menschheit: Vierzehn historische Miniaturen. Fischer Taschenbuch Verlag, Frankfurt am Main.
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Organists and organ music composers C. Foerch*, Michael G. Hennerici†,1 *Department of Neurology, Goethe-University, Frankfurt am Main, Germany Department of Neurology, Universita¨tsmedizin Mannheim, University of Heidelberg, Mannheim, Germany 1 Corresponding author: Tel.: +49 621/383-2885; Fax: +49 621/383-380, e-mail address: [email protected]
†
Abstract Clinical case reports of patients with exceptional musical talent and education provide clues as to how the brain processes musical ability and aptitude. In this chapter, selected examples from famous and unknown organ players/composers are presented to demonstrate the complexity of modified musical performances as well as the capacities of the brain to preserve artistic abilities: both authors are active organists and academic neurologists with strong clinical experience, practice, and knowledge about the challenges to play such an outstanding instrument and share their interest to explore potentially instrument-related phenomena of brain modulation in specific transient or permanent impairments. We concentrate on the sites of lesions, suggested pathophysiology, separate positive (e.g., seizures, visual or auditory hallucinations, or synesthesia [an involuntary perception produced by stimulation of another sense]) and negative phenomena (e.g., amusia, aphasia, neglect, or sensory-motor deficits) and particularly address aspects of recent concepts of temporary and permanent network disorders.
Keywords organist, composer, music, neurology, disease, seizure, stroke
1 INTRODUCTION Of all mental faculties, music shows the clearest signs of nonverbal communication— in all cultures and from unknown centuries until today mankind have enjoyed music. Singing and instrument playing are also among the oldest systems of communication either involved into speech or itself as a special form of speech. While performance and reception of music depend on sensory-motor capacities and education, cognitive functions and creativity are independent from musical perception but can focus on separate specific abilities, ranging from tone deafness and amusia to musical genius independently of other measures of intelligence including language. Progress in Brain Research, ISSN 0079-6123, http://dx.doi.org/10.1016/bs.pbr.2014.11.032 © 2015 Elsevier B.V. All rights reserved.
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Clinical case reports of patients with musical dysfunction provide clues as to how the brain processes musical ability and aptitude: from clinical investigation and psychological testing of normal, educated, or professional musicians to different stages of sedation or brain damage, the mosaic illustrates the complexity of the brain network, which is far from understood: even in times of functional brain-imaging studies, illustrating sites and timing of musical paradigms during imagination and performance in genius, healthy, aging, and diseased, or demented people. This chapter is written by two neurologists and active organists, who have passed a separate musical education in parallel to their medical training and performed organ playing in church services as well as concert performances. However, both are scientific academic neurologists with strong experience in clinical neurology and for years have studied with particular interest in disorders of musical capacities in their patients suffering from various diseases: from onset of symptoms to recovery, may they be partial or even full with physical and mental independence eventually. We have also been interested in the search of illustrative examples of neurological problems as reported from professional, famous artists (and organ players/composers in particular), some of them are listed in the following text: according to traditional neurological investigations, we will concentrate on the sites of lesions and suggested pathophysiology, separate positive (e.g., seizures, visual or auditory hallucinations, or synesthesia [an involuntary perception produced by stimulation of another sense]) and negative phenomena (e.g., amusia, aphasia, neglect, or sensory-motor deficits) and particularly address aspects of the more recent concept of temporary and permanent network disorders and cortico-subcortical circuit dysfunction (e.g., very common in patients with subcortical vascular encephalopathy and vascular dementia from small vessel disease in chronic atherosclerosis). In the future, probably the most challenging tasks for neuroscientists and clinicians will be to better understand the mechanisms of continuous repair or reset of brain programs for healthy aging: a provocative look at how new research is highlighting the emerging powers of the aging mind was formulated in the Wisdom Paradox by the world-renowned neuropsychologist Elkhonon Goldberg (2006): he argued that though mental abilities (such as recent memory recall) decline as the mind enters the “autumn season” of our life span, the brain becomes more powerful in its ability to recognize specific patterns. Preserved or regained musical communication abilities may be of particular interest and importance once old healthy individuals make decisions at more intuitive levels—a late-emerging mental strength Goldberg termed “wisdom.”
2 CLASSICAL AND CHURCH ORGANISTS AND ORGAN MUSIC COMPOSERS The majority of organists, both amateur and professional, are basically involved in church music, where the pipe organ plays the leading role in traditional Christian worship. Depending on the churches, culture, denomination, local settings, and
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standards of the organists, a wide variability of musical pieces can be produced: different from any other instrument, even if a full romantic orchestra is considered—by one person only playing on up to six keyboards plus pedal with his hands and feet, the same composition with uncountable numbers of different colors and impressions. Beyond other musical instruments, most of the literature composed for organ have been written by organists themselves, and many of them have been excellent in spontaneous improvisation: Johann Sebastian Bach, Dietrich Buxtehude, Felix Mendelssohn, Franz Liszt, Ce´sar Franck, Camille Saint-Saens, Charles Marie Widor, Marcel Dupre, Maurice Durufle, etc. The organ (from Greek organon ¼ instrument) is a keyboard instrument of one or more divisions, each played either with the hands or with the feet. In the Western musical tradition, it dates back from the time of Alexandria. It was introduced in the church worship only during the fifteenth and sixteenth centuries in Europe. Since then pipe organs have used various materials for pipes that cover wide tonal volumes. They are divided into separate or mixed pipe ranks and controlled by the use of hand stops and/or combination pistons. Although the keyboard is less impulsive as on a piano, dynamics are to be controlled by the different mechanical/electronic structures of the instrument and dynamics originally designed by the organ builder. All instruments vary in size and sound characteristics; they are unique like artists’ paintings in churches, synagogues, and concert halls or even homes. The pipe organ existed in its current form since the fourteenth century and was considered to be the most complex human-made mechanical creation before the Industrial Revolution. The biggest instruments have 64 ft pipes and have sounds down to an 8 Hz frequency fundamental tone, nearly unrecognized even by young human beings. Perhaps, its most distinctive feature is the ability to range from the slightest sound to the most powerful discharge comparable with huge romantic symphony orchestras. In the nineteenth and twentieth centuries, organ music became more and more independent from church services, and in particular in French-speaking countries, organ recitals even replaced symphony orchestras by playing transcriptions of orchestral pieces (Edward Elgar, Charles Marie Widor, and Ce´sar Franck). Similar to the human voice-related antiphonal music of the late Middle Ages and the Renaissance period (Jan Petersen Sweelinck and Girolamo Frescobaldi) with its breath-related spontaneous rhythm modulations, more recent organ music of the twentieth century tended to concentrate on less dramatic effects and even mirrors human and animal singing as recorded from nature (Olivier Messiaen, Jean Alain, etc.).
3 NEUROLOGICAL FINDINGS 3.1 POSITIVE PHENOMENA It is well known that so-called musicogenic seizures are triggered by listening to music—and the trigger might be quite specific (e.g., classical or popular music, a particular piece or a special motif, sometimes existing of a few tones only such as
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in Beethoven’s Symphony No. 5 or Big Ben’s Church Hall Melody). Sometimes even the imagination or reading of the written notes can trigger seizures. Partial seizures may present as musical hallucinations, similarly set up by various stimuli and supposed to originate from the superior temporal gyrus of either hemisphere—they can consist of verbal or nonverbal phenomena and may be associated with impaired vision (e.g., Charles–Bonnet Syndrome). Sutherling et al. (1980) reported a 67-year-old organist with diabetes, who suffered from stereotyped focal seizures of the left lower face, jaw, and neck while playing a certain hymn (Now thank we all our God) on the organ. In contrast, seizures were not induced by reading, singing, or hearing the hymn or by playing the hymn silently (pushed hand stops). If the patient was asked to play this specific hymn on three successive occasions, this was followed by the same partial seizures irrespective of the stop settings; however, if he played another hymn with the same keys, stops, and time sequence, there was no seizure, although this hymn shared some chords with the qualifying one. Interestingly, when he was asked to imitate playing of the inciting hymn by making the appropriate finger movements in the air, this was followed by a seizure. Singing the hymn aloud or in his mind or listening to someone singing or to two other organists playing the hymn, all failed to induce a seizure. This shows that the complexity and specificity of reflex seizures to a musical stimulus are much more difficult to understand than one might have suggested—it obviously mirrors failures or compensates mistakes in a substantially complex interactive network. Similar observations are reported by patients playing music on the piano as well—the unique appearance of this patient was that he had to play this specific composition himself on the organ or at least making the appropriate movements of this particular sequence of notes himself: the different results of silent playing and imitation remain obscure. Unfortunately, brain-imaging studies were not performed in those days. Wieser and Walter (1997) published another case of an organist who during an organ concert had suffered a complex partial seizure. The concert was recorded and analyzed in detail: while the left hand in the beginning of the seizure became imprecise, the right hand remained faultless—with increasing duration, the dissociation of both hands increased but the right hand succeeded in parts compensating for the errors of the left hand in a musically meaningful way. The authors propose that the case illustrates “untroubled musical judgment during epileptic activity of the right temporal lobe” and speculated about “the ability of improvisation in the sense of a perfect musical solution to errors of the left hand.” The patient underwent epilepsy surgery later that gave strong evidence about the origin of the seizures from the right hippocampal formation. Examples of the original score of the piece by John Stanley (1713–1786) and the variation as played by the patient are given in Figs. 1 and 2. Synesthesia is a condition in which stimulation of one sensory modality causes unusual experiences in a second, unstimulated one, i.e., sound produced the perception of colors and vice versa. Hubbard and Ramachandran (2005) reviewed the literature with emphasis on neural cognitive mechanisms suspected to be responsible for synesthesia and Mulvenna (2007) discussed synesthesia in the arts and creativity. Synesthetes do not report their experiences to a physician usually, different from
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FIGURE 1 Original composition Voluntary VIII opus 5 for organ by John Stanley (1713–1786) bars 20–22 (A) and variations as played by the patient (B). Courtesy of Elsevier Publishers from reference 2; (Wieser and Walter, 1997).
FIGURE 2 Musical analysis of seizure-induced variations, beginning with an error of the left hand in the middle of bar 20. (As indicated by arrow and circled numbers; detailed analysis in reference 2; Wieser and Walter, 1997.) Courtesy of Elsevier Publishers.
other episodes like epilepsy, migraine, Charles–Bonnet Syndrome, etc. Used to the complex series of specific moving colors and shapes, induced by an entire musical piece, that will be reproduced unchanged every time, the synesthete hears that piece played with the same instruments. It is recognized as a neurological phenomenon, whether or not it plays an active role or might even be necessary for successful creative output is unknown. However, studies have shown that synesthetic people have higher abilities in creative cognition. The French composer of harmony at the Paris Conservatoire, organist at l´ Eglise de la Sainte-Trinite´ in Paris and ornithologist Olivier Messiaen (1908–1992)— whether a “true synesthete” or not—very precisely reported what he experienced:
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“Colors are very important to me because I have a gift—it’s not my fault, it’s just how I am—whenever I hear music or even if I read music, I see colors.” He claimed peculiarities like the lower range of C-Sharp was “copper with gold highlights,” D-flat was “orange with stripes of pale yellow, red and gold” (if he was a true synesthete, the sound of D-flat would never change from orange and yellow to green or blue). Olivier Messiaen was born in 1908 in Avignon, educated at the Convervatoire Nationale Supe´rieur de Musique et de Danse de Paris from 1919 to 1930 and played an important role in modern East and West European music. Because of his enormous abilities in improvisation, he became a member of the master class of Marcel Dupre´ (1886–1971), who was titular organist at St. Sulpice in Paris and professor of organ performance and improvisation at the Paris Conservatoire. When Oliver Messiaen was 11 years old, he visited the Sainte Chapelle and was overwhelmed by the colors of the stained glass windows: “It is true, I see colors, it is true, they are there— however, as a musician I see musicians’ colors, not to be confused with painters’ colors. They are colors that go with music. If you try to reproduce these colors on canvas, it may produce something horrible. They are not meant for that.” Since the age of 18, Oliver Messiaen has been collecting the songs of thousands of birds throughout France and the world. He found birdsongs fascinating and incorporated transcriptions into his music with very specific rhythm annotations and sound-requests if available in the individual instruments. His innovative use of colors, specific relationships between time and music as well as ancient and exotic rhythms, and his use of birdsongs make his composition distinctive and unique (L´ascension, La Nativite´ du Seigneur, Les corps glorieux) (Fig. 3). Messiaen was inspired by the mystical, natural, and Roman Catholic faith and so was his music.
3.2 NEGATIVE PHENOMENA Negative phenomena without focal lesions are rare not only in organists, but also in clinical neurology. In particular, the interference of transient memory deficits with daily activity and especially musical performance has only recently been investigated in more detail and is still only partially understood: we found a report by Byer and Crowley (1980) about an organist who suffered an episode of transient global amnesia (TGA) during a recital. Despite immediate short-term memory deficits, he continued playing his part of complex organ music to some extent without any recognition in his behavior during the episode: other people can drive a car without making mistakes, register in a hotel, go asleep, and only once they awake the next day, they cannot remember the way it took them and where they found a parking place for their car or how they managed to arrive in this place. The remarkable preservation to conduct, compose, perform, or recognize music in this situation can be explained by small lesions found on magnetic resonance imaging in the hippocampus of these patients, which is a major brain area associated with short-term memory function. Byer and Crowley reported a 66-year-old retired professor of music who was healthy until the night of an organ recital. Like the majority of people suffering
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FIGURE 3 Olivier Messiaen a page from “Oiseaux exotiques” (1955). It illustrates Messiaen’s use of ancient and exotic rhythms (in the percussion near the bottom of the score: “Asclepiad” and “Sapphic” are ancient Greek rhythms, and Nibc¸ankalıˆla is a decıˆ-t^ala from S´a¯rn˙gadeva). It also illustrates Messiaen’s precision in notating birdsongs: the birds identified here are the white-crested laughing thrush (garralaxe a` huppe blanche) in the brass and wind instruments, and the orchard oriole (troupiale des vergers) played on the xylophone. Courtesy of Glarean Magazin 2007.
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with TGA episodes, he was under increased emotional stress during the week prior to the recital. He played the four manual 56-rank organ, which was located at the back of the church while his wife, with whom he performed the duets, was seated at another organ in the front of the church. Because of the distance between the two instruments, timing was difficult anyhow. The first three pieces were familiar to him—although after the episode he did not remember them. During the following concerto by G. F. Ha¨ndel, he failed to change the organ registration and stopped midway in the Andante, changed the registration, and repeated the first 16 measures which his wife realized as “uncharacteristic of him.” In the next Symphonia Festiva by Near, he again failed to change the registration, but played as written. At this point, he had to leave the back of the church and proceed to the front where he was supposed to perform on the harpsichord, which he did not. His wife realized that something was wrong, played the solo herself while he returned to the organ loft at the back of the church. After the concert, he greeted the people, but failed to recall some names of his friends and behaved very strangely: like all patients with TGAs, he typically repeated the same question several times (What day is it? Is it Sunday?) again and again although the answers were given repeatedly. TGA episodes were first described by Fisher and Adams (1958) already in the late 1950s, and clinical diagnosis was easy if considered appropriately. The pathogenesis, however, remained uncertain, and the brain structures involved could not be identified. Today more than 80% of our patients present with characteristic DWI-MR spots in either one or both hippocampi 24–48 h after onset of symptoms (Sedlaczek et al., 2004). It is unlikely that the episode in this organist has anything to do with a specific pattern of musical understanding or performance, but reflects the inability of short memory during or after severe emotional stress in most patients with TGAs: like an unexpected computer breakdown is associated with lack of storage of all material presented, perfect function follows the episode with very low frequency of recurrent episodes. Negative phenomena in the presence of focal lesions are common findings in neurological diseases, however, in combination with musical experiences they are quite rare. However, the available literature points toward a special dissemination of speech and music in the brain. Most remarkable is the case of the famous French organist Jean Langlais (1907–1991), who suffered an embolic infarction in the left middle cerebral artery territory, involving the temporal and the inferior parietal lobes. Details of his medical record including a reprint of the CT scan depicting the infarction have been published in a pseudo-anonymous fashion in French language (Signoret et al., 1987). Later on, it was proclaimed that the patient indeed was Jean Langlais, leading to an update article on what happened at that time in English language (Fisher and Larner, 2008). Since the age of 2 years, Langlais was blind, likely due to a congenital glaucoma with eye infection. At the Institut National des Jeunes Aveugles (National Institute for Blind Children) in Paris, he was taught using braille. Later on, he used the same braille—depending on the context—to read and write language as well as music. Following his studies at the Paris Conservatoire, he was announced organiste titulaire at the Basilica of Sainte-Clotilde in Paris, a
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position he hold for more than 40 years. His music is barely tonal, his themes are often based on simple liturgical chants, e.g., the “incantation pour un jour saint” with its ascending “Lumen Christi” acclamations. Langlais’ stroke occurred while playing in a church service. Initially, the right-handed patient suffered from a right-sided hemiparesis that resolved quickly. Persistent, however, was a severe Wernicke aphasia with jargon aphasia, anomia, difficulties in repetition, and a comprehension deficit. He was not able to read and write in braille any more. On the other side, amusia was not present at all. Langlais was still able to play organ—both according to scores and improvisation. He still read and wrote music, and even composed organ pieces after his stroke. His aphasia persisted within the following months, again indicating that the stroke was severe enough to destruct functional areas in the primary speech areas of the brain. The authors concluded that the description of a stroke in a highly talented musician implicates a dissociation of language and music. In particular, the use of braille in which the same constellation of dots corresponds to either letters of the alphabet or musical notes, supports this hypothesis. The right hemisphere may play a key role in music. This hypothesis is also supported by a rather anecdotal case report of a lay organist that was published by McFarland and Fortin (1982). He was not able to read and write music throughout his life, but he was able to play familial melodies on his organ. At the age of 78 years, he suffered an embolic stroke in the right temporoparietal region (closely related to the Sylvian fissure) that involved the superior temporal and supramarginal gyri, too. Later on, the patient had only slight difficulties recognizing familiar melodies and had no significant motor deficits at all. However, he was not able to play the melodies on the organ any more. This case report again suggested that the right hemisphere might be critically involved in executing music.
3.3 VASCULAR EVENTS In his collection of historical miniatures entitled “Sternstunden der Menschheit” (English translation entitled “Decisive Moments in History”), the Austrian writer Stefan Zweig perceptively describes Georg Friedrich Ha¨ndel’s “resurrection” from the physical impairment and the mental sequelae that hampered him after having suffered a stroke (Zweig, 1964). The miniature starts with a scene at Ha¨ndel’s apartment in London in 1737, right at the time when he developed first symptoms of his stroke. According to Zweig, Ha¨ndel had a right-sided hemiparesis that forced him to immediately quit all musical activities. Following a long period of rehabilitation, he returned to London several months later without any apparent disability. However, while trying to resume composing, he felt weary, lethargic, and depressed. Almost resigned, he returned home one night and detected a new libretto on his writing desk. After having opened the cover, he was able to read the first sentences: “Comfort ye my people”—words that later on will become the opening section of one of Ha¨ndel’s most famous works, the Messiah. These words transformed Ha¨ndel’s mood instantly. With unprecedented creativity, he completed his masterpiece within a few weeks, with minimal sleep and food consumption.
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A less anecdotal and more scientific evaluation of Ha¨ndel’s cerebrovascular disease was published by Ba¨zner and Hennerici (2004). Ha¨ndel, born in 1685 in Halle an der Saale, had a positive family history for cerebrovascular diseases. Most likely he accumulated several vascular risk factors, such as arterial hypertension, smoking, and alcohol consumption. Ha¨ndel suffered his first stroke (the one mentioned in Zweig’s novel) in 1737. Historical documents and early biographies described a paresis of the right extremities, one source even specified that the “palsy took entirely away the use of 4 fingers of his right hand.” In addition, “mental confusion” (probably aphasia) was apparently also a symptom of Ha¨ndel’s stroke. After a long-lasting rehabilitation treatment in the thermal bath Aachen, Ha¨ndel returned to London under the broad attention of the public. He was free of any functional disability and resumed composing and performing music. In 1743 and 1745, some “recurrence of his paralytic disorder” was reported in the historical literature. Apparently, all strokes provoked motor deficits exclusively of the right-sided extremities. The latter strokes most likely did not cause long-lasting symptoms. In 1751, an acute loss of visual acuity did occur in his left eye while composing his oratorio “Jephtha.” Ha¨ndel noted in the score sheet: “Biss hierher komen den 13. Febr. 1751 verhindert worden wegen relaxation des gesichts meines linken auges” (got as far as this on 13th February 1751, unable to go on owing to weakening of the sight in my left eye). Ha¨ndel’s visual disturbance recovered steadily, but worsened again in the following months. From 1753 onward, Ha¨ndel was not able to hand-write his compositions any more, but dictated them. After ophthalmologists made the diagnosis of a cataract, Ha¨ndel underwent several eye operations. All of them were not able to recover his debility of sight. In the article, Ba¨zner and Hennerici suggested potential etiologies for Ha¨ndel’s strokes. Based on the matter of fact that Ha¨ndel suffered three strokes with no longlasting functional residues, leaving him still able to compose masterpieces, lacunar infarctions due to cerebral microangiopathy appears to be a plausible hypothesis. Lacunar strokes have a rather good prognosis and typically do not involve cortical structures. The reported “speech disturbances” may then be interpreted as a “dysarthria clumsy hand syndrome.” On the other side, a severe atherosclerotic carotid stenosis on the left side may have caused several left hemispheric embolic strokes. The above mentioned precise description that “4 fingers” of Ha¨ndel’s right hand were affected, may well lead to the assumption that the cortical hand knob was involved. Although the visual acuity loss was sudden, painless, and monocular, it was longer than a typical amaurosis fugax (which lasts for minutes typically). The authors therefore suggested an ischemic opticus neuropathy, which also can be found frequently in patients with an ipsilateral high-grade carotid stenosis. Ha¨ndel died in 1759 in London and was buried in Westminster Abbey. Recently, Foerch et al. (2012) enlightened the remarkable death of the great French organist and composer Louis Vierne (1870–1937). From early childhood days on, Vierne suffered from severe visual impairment (likely due to a congenital cataract), but was at least able to read text written in large-scale letters. His extraordinary talent in music was refined and shaped by the best organists in Paris, namely Cesar Franck and Charles Marie Widor. For many years, Vierne was the principal
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organist at the cathedral of Notre Dame de Paris. Vierne died probably the most “beautiful” death an organist could imagine. He deceased right at his beloved organ console at the “Notre Dame” cathedral in Paris while playing an organ concert. Eye witnesses reported that Vierne was in the midst of performing his “Matinee,” a calm and meditative three-movement piece for organ solo, when suddenly his hands started to cramp. Shortly thereafter, Vierne lost his consciousness and slid down from the organ bench with his left foot pushing down the low e pedal. This single tone echoed through the cathedral for a while. Most of the respective literature on this incident considered a stroke as being the most likely cause of Vierne’s death. However, a critical revision from a medical perspective taking into account the preceding shortness of breath, the sudden death, and the lack of focal neurological signs or headache led to the conclusion that a primary cardiac event is more likely to assume.
REFERENCES Ba¨zner, H., Hennerici, M.G., 2004. Georg Friedrich Ha¨ndel’s strokes. Cerebrovasc. Dis. 17, 326–331. Byer, J.A., Crowley Jr., W.J., 1980. Musical performance during transient global amnesia. Neurology 30, 80–82. Fisher, C.M., Adams, R.D., 1958. Transient global amnesia. Trans. Am. Neurol. Assoc. 83, 143. Fisher, C.A.H., Larner, A.J., 2008. Jean Langlais (1907–1991): an historical case of a blind organist with stroke-induced aphasia and Braille alexia but without amusia. J. Med. Biogr. 16, 232–234. Foerch, C., Lemercier, S., Hennerici, M.G., 2012. A beautiful stroke? A side note on the 75th anniversary of the spectacular death of the French organist and composer Louis Vierne (1870–1937). Cerebrovasc. Dis. 34, 322–325. Goldberg, E., 2006. The Wisdom Paradox. Gotham Books, New York. Hubbard, E.M., Ramachandran, V.S., 2005. Neurocognitive mechanisms of synesthesia. Neuron 48, 509–520. McFarland, R., Fortin, D., 1982. Amusia due to right temporoparietal infarct. Arch. Neurol. 39, 725–727. Mulvenna, C.M., 2007. Synaethesia, the arts and creativity: a neurological connection. In: Bogousslavsky, J., Hennerici, M.G. (Eds.), Neurological Disorders in Famous Artists. Part 2. Frontiers of Neurology and Neurosciences, vol. 22. Karger Publishers, Basel, pp. 206–222. Sedlaczek, O., Hirsch, J.G., Grips, E., Peters, C.N., Gass, A., W€ ohrle, J., Hennerici, M., 2004. Detection of delayed focal MR changes in the lateral hippocampus in transient global amnesia. Neurology 62, 2165–2170. Signoret, J.L., van Eeckhout, P.H., Poncet, M., Castaigne, P., 1987. Aphasie sans amusie chez un organiste aveugle. Rev. Neurol. (Paris) 143, 172–181. Sutherling, W.W., Hershman, L.M., Miller, J.Q., Lee, S.I., 1980. Seizures induced by playing music. Neurology 30, 1001–1004. Wieser, H.G., Walter, R., 1997. Untroubled musical judgement of a performing organist during early epileptic seizure of the right temporal lobe. Neuropsychologia 35, 45–51. Zweig, S., 1964. Sternstunden der Menschheit: Vierzehn historische Miniaturen. Fischer Taschenbuch Verlag, Frankfurt am Main.
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