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Phantom Limbs and Updating Our Body Image
Ramachandran and Rogers-RamachandranArticle describe their experience and views of phantom limbs. Perceptual qualia, brain maps, and current concepts of neural pattern coding vs place coding are described to understand how neural activity leads to conscious experience. Our body image may indeed be a purely transitory internal construct.
CliffordArticle provides a concise review of the biological issues related to memory and cognitive loss in patients with human immunodeficiency virus (HIV) infection. Current effective therapy is reviewed and the approach is highly useful for the clinician.
Prescribe Aspirin Carefully
Hart and colleaguesArticle describe a large randomized series of trials to evaluate the preventive effect of aspirin on stroke. They find that people with major risk factors for vascular disease may be intermediate between a substantial decrease in risk for those with manifest vascular disease and a possible small increase for healthy people due to a risk-accentuated intracranial hemorrhage. Choosing aspirin with these parameters in mind to prevent stroke needs to be carefully considered. These and other issues are put into critical perspective in a clear and compelling way in an editorial by Barnett and ElisziwArticle.
DYT1 Mutation in Torsion Dystonia
Brassat and colleaguesArticle from France have evaluated the frequency of the DYT1 mutation in patients with idiopathic torsion dystonia but without a positive family history. As they show, screening for the DYT1 deletion even without a family history can yield positive results. Thus, this gene needs to be screened in isolated patients with generalized dystonia. BirdArticle expands these concepts and approaches in a thoughtful accompanying editorial.
MRI Measurement of Alzheimer Disease
Fox and colleaguesArticle have studied serial magnetic resonance imaging (MRI) volume images in patients with Alzheimer disease to evaluate the rate of brain atrophy as a marker of disease progression. They find this approach provides a powerful method of quantification of brain atrophy, which indeed can be used to monitor progression of Alzheimer disease in clinical trials. This theme is amplified in a thought-provoking, therapeutically oriented editorial by KayeArticle.
Diagnosing Lewy Body Dementia
Hohl et alArticle explore the clinicians' diagnostic accuracy for dementia with Lewy bodies compared with that for Alzheimer disease. The criteria to make the separation is difficult, but perhaps the greater emphasis on presence of hallucinations may favor the presence of dementia of Lewy body type.
Katz and RopperArticle describe their clinical laboratory and radiological findings in 9 patients who had progressive idiopathic necrotizing myelopathy. This disorder is difficult to diagnose with a high degree of certainty, but their analysis is thorough, comprehensive, and clinically valuable.
Altered REM Sleep With Temporal Lobe Epilepsy
Bazil and colleaguesArticle show that temporal lobe complex partial seizures decrease REM sleep, particularly when seizures are occurring during sleep but also occurring on the previous day. These findings, in part, may be responsible for the prolonged impairment of functioning that some patients report following seizures.
Evolving Parkinson Disease
Jankovic and colleaguesArticle report that 8.1% of patients initially diagnosed as having Parkinson disease were later found to have alternate diagnoses based on multifactorial clinical diagnostic criteria. As their study shows, even the best experts may have to change their diagnoses, although infrequently, during an 8-year follow-up.
This Month in Archives of Neurology. Arch Neurol. 2000;57(3):305. doi:10.1001/archneur.57.3.305
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