The demise of Archbishop Wolf Dietrich--A historical note on a fatal status epilepticus documented at Salzburg in 1617.
BACKGROUND
Wolf Dietrich of Raitenau (WD) ruled the archiepiscopal Salzburg from March 2nd 1587 to December 17th 1611. He was condemned by his successor Archbishop Markus Sittikus of Hohenems to spend his last years imprisoned at the Fortress Hohensalzburg, where he died on January 16th 1617. This historical note describes the causes of his death.


METHODS
The original Latin handwriting, including the detailed medical history and the autopsy of the Archbishop's body performed by his personal physician, was analyzed in conjunction with historical handwritings provided by St. Peter's Abbey, Salzburg handwriting assigned to Markus Sittikus.


RESULTS
Wolf Dietrich of Raitenau had his first well-documented left hemispheric stroke in winter 1604/05. He had palsy of his right arm, was unable to write, and, therefore, used a stamp instead of his signature until October 1605. After another stroke, right hemispheric in origin with persisting palsy of his left arm ["leva corporis pars iam pridem simili ex apoplectico assultu in paralysin resoluta"], he developed symptomatic epilepsy with recurring seizures ["epileptico insultu quo etiam alias correptus est"]. On January 15th 1617, he suffered from a secondarily generalized convulsive status epilepticus ["toto corpore convellitur epileptico insultu"] with stertorous breathing and distortion of his face ["spuma stertore insigni faciei perversione"] and was unconscious for 8h. He recovered from coma and showed dysphagia, buccofacial apraxia ["abolitam diglutiendi facultatem"], reversible speech disturbance ["accisa etiam verba loqui"], and left-sided hemiplegia ["leva corporis pars… immobilis prorsus est reddita"]. The following day, he had speech disturbances, and he died at noon. His autopsy showed large but intact liver ["hepar magnum sanum"] and heart ["cor magnum in quo lapsus nullus"]. There was intrapulmonal mucus ["pituita imbutus"], and part of the lungs adhered to its pleura. He had five kidney stones and a partly cirrhotic spleen. The cause of his death was assumed to be intracerebral ["causa mortis in capite requienda fuisset"].


CONCLUSIONS
The terminal suffering of Wolf Dietrich of Raitenau is the first witnessed case report on a fatal status epilepticus in Salzburg. Most likely, he suffered from vascular epilepsy due to a right hemispheric stroke, leading to status epilepticus with left-sided Todd's palsy and speech disturbances. An acute symptomatic etiology of this disease cannot be ruled out, as for religious reasons, the Archbishop's brain was not autopsied.


CONCLUSIONS
Meticulous medical reporting including autopsy was already available in Salzburg in 1617, and the symptomatic etiology of epilepsy was diagnosed correctly. This article is part of a Special Issue entitled "Status Epilepticus".
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria. Electronic address: g.kalss@salk.at.
Gudrun
G
Kalss
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Julia
J
Höfler
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Alexandra
A
Rohracher
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Ildiko
I
Deak
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Judith
J
Dobesberger
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Department of Neurology, Medical University of Innsbruck, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Austria.
Giorgi
G
Kuchukhidze
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Markus
M
Leitinger
Department of Legal Medicine, Medical University of Graz, Universitätsplatz 4/2, 8010 Graz, Austria.
Kathrin
K
Ogris
Division of Neuroradiology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Mark
M
Mc Coy
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University Salzburg, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, Ignaz Harrer Strasse 79, 5020 Salzburg, Austria.
Eugen
E
Trinka
D001317:Austria; D005197:Famous Persons; D049670:History, 17th Century; D006801:Humans; D008297:Male; D013226:Status Epilepticus / Q000209:etiology / Q000266:history*; D020521:Stroke / Q000150:complications / Q000266:history*
Archbishop Wolf Dietrich; Status epilepticus; Vascular epilepsy