This Month in Archives of Neurology

In a Special Article, HorowitzArticle exhorts his colleagues into action in responding to acute stroke with the urgent administration of tissue-type plasminogen activator (t-PA). He admits that t-PA is not perfect for acute stroke, yet it is more than just "modest" in its therapeutic effect. Although it has its hazards, administration of t-PA clearly has therapeutic benefit. Neurologists need to recognize that this drug represents a new era in the acute management of stroke. His message is a worthy one.

A careful study by Stout et alArticle shows that HIV infection may cause progressive brain atrophy even in the absence of cerebral opportunistic disease. Atrophy was present even in medically asymptomatic HIV-positive individuals. The observations in this article are both clear and dramatic in their implications.

Males and females are different even regarding age-related changes in brain structure. Coffey et alArticle report that age-related changes in brain size were significantly greater in males than females in specific areas. Other areas, including cerebral hemisphere volume, were neutral to sex with the aging process. This study is an important one and points out the neurobiological bases and functional correlates of these sex differences with age.

Jorda et alArticle applied sensitive immunocytochemical stains on cerebrospinal fluid specimens from patients with leptomeningeal carcinomatosis and found a high degree of positive responses. Using this approach, the sensitivity of a cytologic diagnosis of meningeal carcinomatosis increases significantly.

The clinical profile of demyelinating optic neuritis in African Americans in comparison with other ethnic groups was studied by Phillips et alArticle. They found that African American study patients with a single episode of demyelinating optic neuritis suffered more acute visual loss compared with other patient groups and that study patients developed multiple sclerosis more frequently. The natural history of a disease must be considered from multiple epidemiological perspectives.

The neuropathology of Alzheimer disease (AD) is well known by examining tissue from either hemisphere. Hampel et alArticle have measured tissue from between the hemispheres, namely, the corpus callosum, and found that total corpus callosum area was significantly reduced in patients with AD, reflecting neuronal loss of projection fibers constituting the structure of corpus callosum. It is an interesting and important observation that can be measured readily by magnetic resonance imaging scans.

Longstreth and colleaguesArticle have examined carefully the important issue that physical activity may put one at risk for developing amyotrophic lateral sclerosis. They look at many sides of this issue and conclude that a history of physical activity has little effect on the risk of developing this disease. Their thoughtful analysis is interesting and convincing.

Acute migraine has been treated in many ways with elaborate regimens. Lipton et alArticle have returned to acetaminophen, aspirin, and caffeine and found impressive reduction in migraine headache pain intensity with this treatment. Their study requires one to reconsider this readily available, inexpensive, and tolerated approach as a mainline form of therapy.

Louis et alArticle studied "normal" subjects for clinically detectable tremor and found a very high percentage of individuals affected. Their study establishes more realistic standards for the concept of normal tremor.