This issue of ACNR brings two review articles on related topics – one on the genetics of stroke and the other on carotid artery angioplasty and stenting.

Hugh Markus and Steve Bevan in their article on the genetics of stroke present a marvellous account on single gene disorders associated with stroke (e.g. Notch 3 and CADASIL) whilst also engaging in the much thornier issue of the role of genetic factors in sporadic stroke. This raises many issues, which are not unique to stroke, but are common to multifactorial disorders – namely proving causality and true aetiological risk in studies showing a degree of genetic association. This review is therefore a wonderful distillation of this complex field whilst also providing some very useful summary information, including a great table summarising the rare single gene disorders associated with stroke.

Continuing the theme, Hans Peter Haring and colleagues in Austria discuss the current status of interventional carotid artery procedures such as stenting and angioplasty. This is an emerging area, although the origins of these procedures go back almost 20 years. In their article the authors critically evaluate this field including completed as well as ongoing clinical trials using these different approaches and how they compare to carotid endartectomy. This field is therefore an exciting area and we are fortunate to have such an authorative account of this controversial field.

It is also worth highlighting that in this issue we have the first in our “Controversies” series, which also has a stroke flavour. Paul Syme presents his approach to the diagnosis and treatment of small vessel occlusive disease using transcranial doppler ultrasonography.

The second topic in our management series on Neurosurgery tackles meningiomas. This relatively common brain tumour can present in a variety of ways and poses a number of challenges to the clinician. This includes questions on whether to operate (as they are typically slow growing) as well as how to operate given their often large size and location in some cases (e.g. para-saggital region). Anne Moore reviews her practice and delivers a beautifully clear and balanced discussion of these issues with a plethora of radiological illustrations.

In our neuropathology feature, Susan Robinson and William Stewart discuss meningitis and cerebral abscesses. This article combines clinical practice with neuropathological findings highlighting the dialogue that has to exist between these two disciplines of neuroscience. In particular the authors lay out the common causes of meningitis and how this can vary with immune status, and provide a wealth of highly informative figures to illustrate the points they make. Thus, in the tradition of this journal, their article speaks across specialities to allow for all of us to adopt a more integrated approach to our clinical practice and neuroscientific understanding.

Our terrific cognitive primer on spatial neglect - by Andrew Parton and Masud Husain - is well-crafted, in line with the excellent articles we have had in this series. Andrew and Masud begin with an account on diagnosis, including useful bedside tests before discussing the anatomy of the phenomena and finally its management – an area that can be a major problem in the rehabilitation of patients with this problem. En route the authors entertain us with an interesting discussion on the cognitive basis for neglect - whether it is due to deficits in attention, spatial mapping or movement initiation.

We also have a special article from the International Parkinson's disease Non-motor symptom scale development group detailing a new questionnaire that seeks to explore the extent and range of non motor symptoms in this common condition. This is an important area, as we often think of Parkinson's disease (PD) in motor terms without any consideration to the range of other deficits that occur, reflecting the diffuse pathology of this condition. A better method of accessing this information is important, not only to raise awareness but to help plan therapy including new experimental approaches.

In the rehabilitation article, Rory O’Connor discusses musculoskeletal complications of neurological conditions that can occur as part of the original insult as well as secondary to neurological disability. This is clearly a very important area, as it is all too easy to see every complaint in a patient through one pair of diagnostic spectacles – the frozen shoulder to a rheumatologist being a radiculopathy in the eyes of a neurologist. The article addresses these issues, as well as how best to manage them pharmacologically and with physiotherapy. This well written account is clearly based on extensive experience and as such is immediately accessible and useful to all involved in this area of neurological practice.

This web site contains all the previous back issues of the journal along with illustrative case reports, and this will include a new one on meningitis by Alastair Wilkins, as well as additional reviews and conference reports. Do keep the feedback coming, and let us know if you are interested in becoming a journal reviewer.

Roger Barker
AdvancesinCNR@aol.com