Congenital cranial dysinnervation disorders (CCSDs) cover a range of conditions which are now starting to be understood at the gene level, and as such have been instructive in helping to put basic embryological processes into clinically relevant neurology and vice versa. It is this topic which Nick Gutowski and Sian Ellard discuss in their excellent review article, which takes us from the familiar syndromes of Duane and Mobius to a range of lesser known conditions. These authors are still actively recruiting CCDD cases, so do feel free to contact them if you encounter such cases.

In the second review article, Adolfo Bronstein treats us to a terrific account on benign paroxysmal positional vertigo (BPPV) which is distilled from his vast experience of all things neuro-otological. This common disorder accounts for 20-30% of all cases referred to specialist vestibular clinics and is readily treatable with either the Epley or Semont manoeuvre. This latter manoeuvre is easily remembered as “take your patient quickly in a big swing from the symptomatic ear down to the opposite eye down”. This review is nicely illustrated with links to video websites of the procedures, and as one would expect from such an author is a great education.

The succinct account on cerebrovascular disease by Allder and Mukonoweshuro continues our neuropathology series. This review lists the common, as well as rarer causes of this disorder and again comes with clear illustrations. The discussion also includes a section on lacunar infarction, which has its neurological origins in the work of Dr CM Fisher. This great neurologist will be describing his variant of the Guillain-Barre syndrome in a future issue of ACNR.

In the neurosurgery series of articles, we remain in the realm of the cerebral vasculature, as Pawan Minhas deals with intracerebral haemorrhage. In this account the causes, presentation, medical and surgical management of this condition are laid out with great clarity, and the article includes references to several recent important trials. These include the value of early surgical intervention (the STICH trial) which concludes that this is probably not a useful manoeuvre, in contrast to the use of recombinant activated Factor VII administration. Both these studies highlight how this field is moving forward, although it is sobering to remember that patients presenting with a Glasgow Coma Score of 8 or less have “an almost universally poor outcome”.

John Shneerson is well recognised as the UK expert on sleep, and in his rehabilitation article he discusses the causes of excessive daytime somnolence following brain injury. This includes a discussion on the rare (e.g. Kleine-Levine syndrome) to the more common (e.g. sedative drug side effects). This list of causes is framed by a discussion on the physiology of sleepwake cycling in the human brain and drugs known to be of therapeutic value in its management of sleep disorders. This clear account is a wonderful summary of a complex field by a renowned expert.

Journal reviews this issue concentrate on the amygdala and novel therapeutic strategies in neurological disease, especially with respect to motorneuron disease and Alzheimer’s dementia. This issue of ACNR also features an article on ‘Neuromarketing’ by David Lewis and Darren Bridger. This is the emerging (pseudo-)science which uses new imaging type techniques, especially fMRI, to gauge the marketing/effect/success of products. This has now evolved to the point where new fMRI facilities are being built purely for marketing research - reported at 8 in the US last year. The rationale for this approach is clearly outlined in this provocative article, and includes discussion on the paper from Neuron last year on what happens in the brain when you are given the choice between Coke and Pepsi.

Finally thanks for all your support and feedback. Do keep letting us know what you think and what you like to see in ACNR - including relevant case reports organised by Alastair Wilkins (Email: aw255@cam.ac.uk).

Roger Barker
Roger@acnr.co.uk