The curious brain impalement of Phineas Gage
These computer-generated models show how the rod went through in Gage's skull.
May 16th, 2012
05:05 PM ET

The curious brain impalement of Phineas Gage

If you survived a 43-inch-long iron rod shot through your skull, people would still be talking about you more than 150 years later too.

Journey back a moment to September 13, 1848. Phineas Gage, 25, was working as a railroad construction supervisor in Vermont. In preparation for the Rutland and Burlington Railroad that was to be laid down, he was blasting and removing rock. But an explosion went awry, shooting a 13-pound iron rod through Gage's left cheek, passing behind his left eyeball and through his brain.

The fateful rod was found later "smeared with blood and brains," according to reports about the case.

Gage survived for almost 12 years after this accident, but people who knew him said he was no longer himself - he exhibited personality and behavior changes.

He couldn't come back to his railroad job, so he took up some manual labor jobs. He ended up traveling in New England and down to Valparaiso, Chile; his iron rod never left his side. He rejoined his family in San Francisco and died on May 21, 1860, probably because of seizures connected to the freak accident.

Now, scientists have new insights into Gage's brain.

A new study in the journal PLoS ONE examines the damage to the connections between the networks in Gage's brain, finding that this probably contributed to Gage's documented behavioral changes.

Researchers compared information about Gage's skull to magnetic resonance imaging (MRI) scans of the brains of 110 right-handed men between ages 25 to 36, the age range at which Gage lived with his injury. In this way, they simulated the trek of the rod through Gage's skull and assessed damage to cortical gray matter (found in memory regions among others) and white matter (which has been implicated in learning and cognition).

"If the rod had penetrated his brain at any other angle, even slightly different than the trajectory that it took, it might have pierced some major cerebrovasculature, and taken his life," said the study's lead author Jack Van Horn, assistant professor in the department of neurology at UCLA School of Medicine in Los Angeles.

Researchers concluded that while the rod intersected with about 4% of the cortex, the accident damaged 11% of white matter. That means that the damage wasn't localized to the part of the brain the rod traversed and the gray matter within. Instead, the connectivity between many important regions of the brain broke down.

The patterns of damage they found is not much different from what's seen in Alzheimer's disease, frontotemporal dementia and traumatic brain injuries.

Mapping strategies like this would be important for measuring the degree of damage that people with traumatic brain injuries experience, Van Horn said. They reveal the effect of the damage on the network connectivity of the brain and the properties of the networks. This could have implications for assessment, monitoring and treatment opportunities for patients.

Over 1 million people sustain a traumatic brain injury every year in the United States, but perhaps no one is as historically famous for surviving one as Gage.

"Hopefully this kind of thing helps us to understand a little more about what he went through, about what his brain injury meant, and how, by understanding that, it might be helpful for modern day traumatic brain injury and degenerative disease patients," Van Horn said.

Gage's skull is currently on display at the Warren Anatomical Museum at Harvard University.

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