During my 1-year residency in neurology at the Mayo Clinic in 1973 to 1974, I greatly profited from Clark Millikan's unusual abilities as a clinical teacher. I had started my neurological training in Copenhagen and wanted to supplement my education by 1 year at the Mayo Clinic. Millikan held his weekly clinics where cerebrovascular cases were discussed. He taught us about transient cerebral ischemia and the many factors contributing to or causing the transient ischemic attacks in patients with or without atherosclerosis of the cerebral or extracranial arteries. He taught us to watch for small emboli in the retinal arteries with our ophthalmoscopes, especially to look for cholesterol crystal emboli in patients with amaurosis fugax, and to listen for bruits over the carotid arteries with our stethoscopes. This was before ultrasound was available as a clinical examination and when contrast angiography was routinely used as the gold standard. Carotid endarterectomy was undertaken by the neurosurgeon Thoralf Sundt. At that time, CT scan of the brain had just been introduced. It was a marvel, mostly used, however, in patients suspected of a brain tumor.
CT scan was not available for patients with an acute stroke. When patients were considered most likely to have ischemic lesions, they were treated with dose-adjusted intra-venous heparin. Aspirin had not yet been shown to have stroke-preventing properties.
Apart from being brilliant as a teacher, Clark was hospitable and invited the whole team of neurology residents for dinner in his home. To my surprise, the young male doctors arrived in shorts. They were “dressed down,” a custom then unknown in Denmark, whereas at the clinic they were all nicely dressed with ties.
After my return to Copenhagen, we arranged a meeting in the Danish Neurological Society with Millikan as the main speaker. Since then, my husband and I have enjoyed many encounters with Clark and his wife, Nancy Futrell, at stroke congresses in the United States and Europe.
In 1970, Millikan had started the journal Stroke to create a platform for publications of studies in cerebrovascular disease. I got the opportunity to publish an article in its first volume. The journal became a tremendous success and is still the leading journal within cerebrovascular disease.
Clark Millkan's achievements in cerebrovascular disease will be remembered.
Gudrun Boysen, MD, DMSc
Department of Neurology
University of Copenhagen
- Received February 5, 2011.
- Accepted February 8, 2011.
- © 2011 American Heart Association, Inc.