To the Editor:
I read with interest the article by Barnett that addressed the ancient descriptions of the carotid artery.1 This work may further benefit from the consideration of some significant historical repercussions of neurovascular disease in the ancient world. The Battle of Halule in 691 BC marked a key period in the Ancient Near East. It demonstrated the complex power balance fought between the Ancient Assyrian Empire and a unique conglomeration of kingdoms that eventually became the Persian Empire (Figure).
Although the Assyrians led by the biblically mentioned Sennacherib initially lost the battle, they were subsequently able to reinvade Babylon 2 years later. This had resulted from the opposing Elamite king Humban-Nimena III (rule, 692 BC to 689 BC) dying from a stroke, described as “his mouth seized so that he could not speak.”2,3
The Assyrians continued to maintain the upper hand as a subsequent Elamite leader, Humban-Haltash I (brother to Humban-Nimena III) ,also died from a stroke.2 Although the description of stroke may have existed as early as the second millennium BC,4 the description of the neurovascular disease in the Elamite kings is the first account of stroke within the same family >2.5 millennia ago. Such neurovascular mortality in successive Elamite kings is likely to have contributed significantly in the determination of the sociopolitical climate of that era.
Barnett HJ. Reflections on the carotid artery: 438 BC to 2009 AD: The Karolinska 2008 Award Lecture in stroke research. Stroke. 2009; 40: 3143–3148.
Leick G. Who’s Who in the Ancient Near East. London, UK: Routledge; 1999.
Potts DT. The Archaeology of Elam: Formation and Transformation of an Ancient Iranian State. Cambridge, UK: Cambridge University Press; 1999.