In Memoriam - Jacqueline M. S. Winterkorn, MD, PhD: Master of Neuro-Empathology

On July 11, 2015, the neuro-ophthalmology community lost one of its most brilliant and compassionate practitioners: Jacqueline Marjorie Schuker Winterkorn. Venerated by her colleagues for her insights and observations, adored by her patients, and loved by her family and friends, Dr. Winterkorn left behind a prodigious corpus of scholarly contributions to the field, and left an indelible mark on every patient, student, resident, colleague, and friend with whom she came in contact.

In Memoriam Jacqueline M. S. Winterkorn, MD, PhD: Master of Neuro-Empathology Dr. Winterkorn with Dr. William Hoyt and Dr. Myles Behrens, her former fellowship director, at the American Academy of Ophthalmology meeting in 1994. "A doc must listen with sensitive ears To hear the patient's secret fears." - J Winterkorn O n July 11, 2015, the neuro-ophthalmology community lost one of its most brilliant and compassionate practitioners: Jacqueline Marjorie Schuker Winterkorn. Venerated by her colleagues for her insights and observations, adored by her patients, and loved by her family and friends, Dr. Winterkorn left behind a prodigious corpus of scholarly contributions to the field, and left an indelible mark on every patient, student, resident, colleague, and friend with whom she came in contact. EARLY LIFE AND CAREER Born in Queens in 1947, Dr. Winterkorn was the child of two lifelong educators, whose passion for learning she must have fully absorbed. Skipping two grades, she entered college at Wellesley at age 16 years, completing her studies in psychology at Barnard. She obtained a PhD in neuroscience at Cornell University, studying the role of the superior colliculus in visual learning in cats and publishing extensively on the subject in the years that followed (1,2). She quickly made a name for herself as a premier educator, teaching the first year neuroanatomy course and finally was pulled over to the "other side," managing to enter medical school in the third year, having shown her expertise in the preclinical curriculum. This was followed by a residency in ophthalmology at the Mt. Sinai Medical Center and a neuro-ophthalmology fellowship at Columbia with e6 Drs. Myles Behrens and Jeffrey Odel. During her fellowship, she wrote voraciously and organized frequent social gatherings, often hosting both her mentors at her home. She went on to practice at Manhattan Eye and Ear Infirmary, Long Island Jewish Hospital, All-City Ophthalmology in Queens, and at Weill Cornell Medical College, eventually as Professor of Ophthalmology and Director of NeuroOphthalmology. She continued at the clinic in Queens and at Cornell until the day she died, shaping a generation of medical students and residents in the arts of her trade. She was an honored member of the North American Neuro-Ophthalmology Society (NANOS), where along with Deborah Friedman, she founded Women in Neuro-Ophthalmology (WIN), which today supports hundreds of women in the field. FAMILY AND COMMUNITY Dr. Winterkorn was blessed with a loving family. Her husband, Dr. Thomas Meikle, Dean of Cornell University Medical College and later president of The Josiah Macy Jr. Foundation, which is devoted to medical education, collaborated with her on her early neuroscience research. Some years after his passing, she rekindled a friendship with her old friend from summer music camp, a retired lawyer and professor, David Lincicome. The two fell in love and created a partnership in which David became not only her husband but her trusted chief ophthalmic technician. Her two daughters carry the spirit of their mother's brilliance with them in their professional careers. Both are Harvard graduates. Dr. Elisabeth Winterkorn, also a Cornell MD, is pediatrician and medical director of a large private practice in North Andover, MA. Margaret Winterkorn Meyers trained at Columbia Law and practices in the litigation department of Richards Kibbe & Orbe in Manhattan. Dr. Winterkorn not only reserved her generosity of spirit for her patients and students, but also was beloved by her community in Connecticut at the Roxbury Congregational Church. Whether she was running an ice cream social, a woman's luncheon, a progressive supper, or a choir rehearsal, she was always bringing people together. When Margaret contracted meningitis as an infant, Dr. Winterkorn made a deal with God that if her daughter recovered fully, she'd spend her life helping people, and she did, both in and out of the hospital. Dinkin and Odel: J Neuro-Ophthalmol 2017; 37: e6-e8 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam NEURO-OPHTHALMOLOGY AT CORNELL MEDICAL COLLEGE Dr. Winterkorn was synonymous with neuroophthalmology at Weill Cornell medical college for over 25 years. A neurology resident would have the pleasure of hearing more than 20 "Winterkorn lectures" every year, so that by graduation the resident basically had completed a mini-fellowship. The ophthalmology residents were fortunate to have the same yearly curriculum. Her dedication to teaching was so great that it was a wonder she had time to see patients at all. But her hours lecturing and mentoring students and residents did not stop her from holding long neuro-ophthalmic clinics or from accepting each and every neuro-ophthalmic inpatient consultation that she would catch wind of. And even then, after her overpacked schedule inevitably led to a late departure, she might invite a resident or 2 to her home for dinner. She refused to teach any subject without entertaining her audience, infusing humor and aphorisms at every corner. "Spare the (Maddox) rod, and spoil the diagnosis," and "this patient has intractable meshuganosis," may have been sayings passed on by former generations of neuro-ophthalmologists, but she pulled them off with a quick, dry wit that kept a generation of residents coming back for more. SCHOLARLY CONTRIBUTIONS Dr. Winterkorn's contributions to neuro-ophthalmology touch on every corner of the field, with early observations of optic chiasmal neuritis (3) the neuro-ophthalmic complications of paraneoplastic disease (including downgaze ophthalmoparesis [4] and a tonic pupil [5]) and the neuro-ophthalmic complications of intracranial shunts (6,7). She described combined central retinal vein occlusion and central retinal artery occlusion in patients with idiopathic orbital inflammation (8) and detailed features of anterior ischemic optic neuropathy (AION) in children on chronic peritoneal dialysis (9). But her most significant contributions related to ischemia. Her detailed description of segmental luxury perfusion after AION (10) helped shine a light on this often missed feature, and in collaboration with Dr. Klara Landau, she demonstrated that patients with AION had a reduced mean diastolic blood pressure in the day time, and a lag in the usual climb in morning blood pressure, as compared with controls (11). These results contributed to the recognition that patients with AION may have a systemic problem with small vessel autoregulation and should avoid excessive treatment of systemic hypertension. Of all her keen clinical observations, one stood out in her mind as particularly memorable. Indeed, she could recall in great detail the day a patient with 6 weeks of daily amaurosis walked into her clinic and proceeded to experience an event while being examined, allowing her to Dinkin and Odel: J Neuro-Ophthalmol 2017; 37: e6-e8 visualize complete loss of central retinal artery perfusion, the presence of retinal pallor, and a relative afferent pupillary defect. This occurred in the absence of any embolic material and resolved within 12 minutes (12). Given the daily history of events, Dr. Winterkorn was convinced that she was watching vasospasm of the central retinal artery. This unique observation was less a stroke of good luck and more a reflection of fierce determination- for Dr. Winterkorn was the kind of physician who would keep such a patient in her clinic as long as it took to observe their disease first hand. Perhaps most impressively, her patients never doubted that their protracted habitation in her clinic was in their best interests, because after a few minutes with Dr. Winterkorn they knew she would do anything to make a proper diagnosis, and as a consequence, treat their condition properly. Indeed, her knack for making difficult diagnoses was matched by her ingenuity in treating them, exemplified by the complete cessation of her patient's amaurosis with the administration of a calcium channel blocker. Her landmark report on this novel treatment for vasoconstrictive amaurosis in 9 patients (13), along with a subsequent success story in a gentleman with recurrent amaurosis associated with orgasm (14), helped define a treatment for a neuro-ophthalmic disease-no easy feat in a clinical field with relatively few treatments. HER PERSONAL STRENGTH WAS INFECTIOUS Dr. Winterkorn made no secret of her long-term battle with Parkinson disease, which she developed at a relatively early age, but there was not even a moment that she let it slow her down and she never let it define her. She was one of the patients to receive dopaminergic fetal stem cell therapy ("those baby cells" as she would refer to it), before it was abandoned in favor of deep brain stimulation, and although it may have contributed to some hyperkinetic movements, there was no doubt it seemed to have slowed the disease. "I was one of the few success stories" she would tout. But her condition did not stop her from seeing a long line of patients, then running across the street to give a noon conference, and running back to the clinic for more patients. She never once considered cancelling a lecture because of her disease, and just as she seemed to pay her condition little mind, so did those around her. In fact, not only did her movement disorder fail to bother her patients, it engendered a deep respect in them for her perseverance and dignity. Although some physicians strive for an appearance that they are somehow on a plane above humanity, Dr. Winterkorn's struggles were laid bare for her patients to see, and in seeing that, her patients felt a great empathy and compassion. Dr. Winterkorn's magic was the combination of a clinical brilliance that was up in the clouds with a humanity that was down to earth. Once patients met her, they would e7 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. In Memoriam keep coming back, even once their neuro-ophthalmic problem was solved, and many would keep in touch with her outside the office, valuing her advice and her friendship. When she died, one after another they would come to the Cornell neuro-ophthalmology clinic looking for that rare amalgam of scientific understanding and just plain understanding. Some were looking for that dedicated steward of compassion for their problems, whether they related to their eyes, their brain, or their life. The vacuum left in her patients' lives is matched only by that of her colleagues, friends, and family, who were lucky enough to experience the gift of her life in theirs. Marc J. Dinkin, MD Departments of Ophthalmology and Neurology, Weill Medical College, New York, New York Jeffrey G. Odel, MD Weill Cornell Medicine Ophthalmology (MJD), New York, New York; and Department of Ohthalmology (JGO), Columbia University Medical Center, New York, New York REFERENCES 1. Winterkorn JM. Visual discrimination between spatially separated stimuli by cats with lesions of the superior colliculuspretectum. Brain Res. 1975;100:523-541. 2. Winterkorn JM, Meikle TH Jr. Distractibility of cats with lesions of the superior colliculus-pretectum during performance of a 4choice visual discrimination. Brain Res. 1981;206:345-360. e8 3. Newman NJ, Lessell S, Winterkorn JM. Optic chiasmal neuritis. Neurology. 1991;41:1203-1210. 4. Schiff ND, Moore DF, Winterkorn JM. Predominant downgaze ophthalmoparesis in anti-Hu encephalomyelitis. J Neuroophthalmol. 1996;16:302-303. 5. Bruno MK, Winterkorn JM, Edgar MA, Kamal A, Stübgen JP. Unilateral Adie pupil as sole ophthalmic sign of anti-Hu paraneoplastic syndrome. J Neuroophthalmol. 2000;20:248-249. 6. Molia L, Winterkorn JM, Schneider SJ. Hemianopic visual field defects in children with intracranial shunts: report of two cases. Neurosurgery. 1996;39:599-603. 7. Shults WT, Hamby S, Corbett JJ, Kardon R, Winterkorn JS, Odel JG. Neuro-ophthalmic complications of intracranial catheters. Neurosurgery. 1993;33:135-138. 8. Winterkorn JM, Odel JG, Behrens MM, Hilal S. Large optic nerve with central retinal artery and vein occlusions from optic neuritis/perineuritis rather than tumor. J Neuroophthalmol. 1994;14:157-159. 9. Chutorian AM, Winterkorn JM, Geffner M. Anterior ischemic optic neuropathy in children: case reports and review of the literature. Pediatr Neurol. 2002;26:358-364. 10. Friedland S, Winterkorn JM, Burde RM. Luxury perfusion following anterior ischemic optic neuropathy. J Neuroophthalmol. 1996;16:163-171. 11. Landau K, Winterkorn JM, Mailloux LU, Vetter W, Napolitano B. 24-hour blood pressure monitoring in patients with anterior ischemic optic neuropathy. Arch Ophthalmol. 1996;114:570-575. 12. Winterkorn JM, Teman AJ. Recurrent attacks of amaurosis fugax treated with calcium channel blocker. Ann Neurol. 1991;30:423-425. 13. Winterkorn JM, Kupersmith MJ, Wirtschafter JD, Forman S. Brief report: treatment of vasospastic amaurosis fugax with calcium-channel blockers. N Engl J Med. 1993;329:396-398. 14. Teman AJ, Winterkorn JM, Weiner D. Transient monocular blindness associated with sexual intercourse. N Engl J Med. 1995;333:393. Dinkin and Odel: J Neuro-Ophthalmol 2017; 37: e6-e8 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.