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When Cold Becomes Hot and Hot Becomes Cold: Unearthing a Historical Report

Mohammadali M. Shoja, Paul S. Agutter, Ghaffar Shokouhi, R. Shane Tubbs


We discuss a curious case of abnormal hot/cold sensation recorded by the renowned medieval Persian physician Nurbakhshi. The patient’s presenting symptoms imply a neurodevelopmental abnormality; however, the most striking feature of Nurbakhshi’s report is the apparent absence of any other pathology, particularly hyperalgesia. This may indicate mis-targeting of A-delta or, more probably, Type 2 C fiber afferents to specific regions of the central nervous system. As far as we are aware, no similar case can be found in the medical literature, medieval or modern. We present a brief biography of Nurbakhshi, a translation of his short report of the case, and a discussion of the possible pathophysiological basis of the condition described. The proposed developmental abnormality may have involved the targeting of unmyelinated afferents to the temperature-responsive regions of the insular cortex, perhaps as a result of defective semaphorin production. An alternative possibility is mutation(s) of one or more genes encoding thermoTRPs.

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