Although patients with Alzheimer disease have a well-demonstrated deficit in cortical cholinergic markers, treatments designed to enhance cholinergic activity in the central nervous system have not achieved the clinical success of dopamine replacement for Parkinson disease. A brief review of recent clinical reports and some developments in the neurosciences suggests that it may be premature, however, to abandon the search for benefit from cholinergic enhancement therapy in Alzheimer disease.
The most prevalent cause of focal brain disease is stroke, Neuroanatomic localization in aphasia--and by inference, the identification of brain regions associated with language functions--is largely determined by, and confounded with, left cerebral hemisphere vascular territories. Traditional nosology of the aphasias, alexias, and agraphias is not always logically coherent and ignores major neurolinguistic boundries, yet it retains the clinical utility of permitting reliable and valid anatomic inferences concerning the underlying neuropathologic substrate.
Disability after severe closed head injury (CHI) differs from that of penetrating trauma or other causes of more focal cerebral damage, but its symptoms can be understood in terms of the pathophysiology and the usual pathology of CHI. Outcome can be quantified by means of specific, narrowly-defined measures, which may fail to reflect other serious sequelae, or by means of functional rating scales, which bear little logical relation to CHI pathophysiology and lump together patients with diverse deficits. The choice of appropriate intake measures of CHI severity in turn depends on which aspects of outcome are to be determined. As the cardinal symptom of CHI is altered consciousness, logical intake measures of CHI severity include measures of the depth and the duration of the abnormal state of consciousness. Confounding factors in outcome prediction include secondary complications of CHI, premorbid characteristics, and effects of acute and rehabilitative therapy. Most research has focused on functional outcome predictions based on simple intake measures obtained shortly after injury, but intake measures that permit accurate prediction of rehabilitation potential or of specific cognitive and behavioral outcomes are also needed.
Three cases of transcortical sensory aphasia in Chinese speakers were associated with left parieto-temporal junction strokes. The possibility that this relatively rare aphasia syndrome is more common in the Chinese is raised and a theoretical explanation based on differences in Oriental written language is presented.
Two additional cases of nonsteroidal anti-inflammatory drug induced meningitis are reported. Consideration should be given to this etiology in all cases of meningitis in which a specific etiology is not found, especially if the meningitis is recurrent.
Radiation therapy may cause accelerated arteriosclerosis of carotid and vertebral vessels which can cause cerebral infarction. This is a late complication which usually occurs several years after therapy and often affects vessels in locations where severe arteriosclerotic change is uncommon.
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