Arthur L. Prensky, 1930–2025

Arthur Prensky, who profoundly influenced two generations of pediatric neurologists, died on June 16, 2025, after a short illness. He was 94 and Professor Emeritus of Neurology at Washington University School of Medicine at the time of his death. His career spanned the evolution of pediatric neurology from a descriptive specialty to a field anchored in modern genetics and neuroscience. After early childhood trauma, including some time in foster care, he attended the highly selective Bronx High School of Science and then graduated Phi Beta Kappa from Cornell. He went on to New York University Medical School and then came to Washington University and Barnes Hospital for medical internship and a 1-year research neurophysiology fellowship. This was followed by service in the Air Force School of Aviation Medicine, ironic since he was phobic of flying. He went on to neurology residency at the Massachusetts General Hospital and an additional 3 years of laboratory research focused on leukodystrophies. In 1967 he "metamorphized" (his own word) into a child neurologist and returned to Washington University to direct a new division of pediatric neurology (Figure 1). In 1974 he was named the first Allen P. and Josephine B. Green Professor of Pediatric Neurology. He had wide-ranging interests and wrote on a variety of topics, including brain lipid metabolism and disorders of myelination; amino acidopathies; epilepsy; toxicity of antiseizure medications; peripheral neuropathies; and Sydenham's chorea. He had an exemplary approach to complicated patients—he tried to formulate as accurate a differential diagnosis as possible but at the end of this process inverted his thinking and asked: Could any treatable condition be present? In this way, he pulled out all stops to make sure his patients did not miss out on potential therapies. He emphasized this approach with residents. In his later years he was especially interested in pediatric headache, with two of his former trainees becoming national authorities on this topic (Andrew Hershey and Kenneth Mack). With several Washington University colleagues, he coauthored books on nutrition and the brain, caring for children with handicaps, and neurological pathophysiology. His skills were recognized by awards and honors, including the Hower Award of the Child Neurology Society, presidency of the Child Neurology Society, and the Faculty Achievement Award of the Washington University Alumni Association. Arthur's formal résumé, however, fails to capture the attributes and eccentricities that gained him such notoriety among child neurologists. He was more than six feet tall and, while physically imposing, was noticeably awkward. He frequently mentioned not only that he walked late but that he only learned to ride a bicycle at 12, with the latter milestone achieved because his success became a neighborhood project. This information was often shared with parents of his motor-delayed patients to give them a more optimistic view of their own child's ultimate potential. He passed his Missouri driving test on the third attempt after explaining to the examiner that he needed to drive to take call at City Hospital. Fine motor coordination was also a challenge. At one departmental softball game, he was permitted unlimited strikes to allow a base hit. In an era when most physicians wore neckties, his were less than pristine. This was recognized by the residents who once gave him a gift of several "pre-stained" ties (Chinese, Italian, and barbecue). He wore them frequently—and proudly. Arthur and his first wife, Sheila (Figure 2), were extremely knowledgeable about modern American art. This artwork filled their first home, a three-story house that dated to the St. Louis World's Fair era. Upon a guest's arrival, Arthur would announce: "Everything is for sale, except for Sheila—and she's for rent." Arthur was not shy about sharing political or personal opinions. When he was aware that a colleague was engaged, he told the fiancé or fiancée: "Big mistake—marry an ophthalmologist." Despite this advice, Arthur again sought love and companionship after Sheila's death by crafting an online profile with the help of a resident and one of the division's nurses. At 80, he met his second wife, Vivian (Figure 3), who upgraded his wardrobe and spirits and encouraged him to overcome his fear of flying to journey to Australia to work alongside several former trainees (Kevin Collins, Andrew Kornberg, and Rick Leventer) at the Royal Children's Hospital in Melbourne. Arthur was extremely generous. This generosity benefited the Washington University community and St. Louis at large. In 2008, he established The Arthur L. and Sheila Prensky Visiting Artist Endowment Fund to bring distinguished artists to the university's Sam Fox School of Design writing – original draft; writing – review and editing. Seth J. Perlman: conceptualization; writing – original draft; writing – review and editing. Steven M. Rothman: conceptualization; writing – original draft; writing – review and editing. The photographs are courtesy of Dr. Prensky's family and from the authors' collections.