For those of you who were too poor to go to the World Congress of Neurology in Sydney and could not therefore see the special issue of ACNR do not worry, as the two new articles in that special issue are reproduced here. This includes a wonderful account by Dr Fisher on his variant of Guillain-Barré syndrome. This article describes how the disorder was first recognised, as well as highlighting the problems of having a surname as a forename. We are very grateful to Dr C Miller Fisher for writing this article for us, which is a great inspiration for all those involved in neurological practice. It is another reminder of the value of keeping notes and details on all the cases that one encounters, especially those without a diagnosis. In addition we also include the article by Geoff Donnan and colleagues on neuroprotection in stroke. This review article highlights the problems of translating encouraging neuroprotectants from the artificial situation with strokes in animals in the laboratory to the rather more messy reality of the clinic. Nevertheless this article does highlight some encouraging trials which offer real hope in the quest to find drugs that will reduce the area of infarction, and by so doing promote recovery and reduce disability.

Our other review article is on one of the emerging new tools of modern science, the zebrafish. These animals are becoming increasing adopted in studies of neurological disorders, and Paul Goldsmith explains why this is the case and the advantages of adopting such an approach based on his own work in this area.

Roy Weller (editor of the neuropathology series of articles) and Nicki Cohen treat us to an illuminating discussion of the neuropathology of dementia, especially Alzheimer’s disease. In this article, they put forward the evidence for the theory that Alzheimer’s disease is as much related to problems of amyloid clearance as it is to production (see also Journal reviews ACNR 5.2). If correct, such a theory would go some way towards explaining the link between amyloid angiopathy in the brain and this type of dementia. In addition, this article also touches upon some of the recent work on amyloid immunisation in patients with Alzheimer’s disease, highlighting what this approach can achieve at the pathological and clinical level.

This issue also contains the first in a new series of articles on the neuroscience of vision, and we are extremely fortunate and grateful to Masud Husain for taking on the editorship of this new departure. The first in the series is on the retina and Sumathi Sekaran and Mark Hankins take us through this structure, which is one of the most beautiful neuronal networks of the nervous system with its interacting vertical and horizontal assemblies of cells. This account highlights the 3 pathways of light detection - rods, cones and the recently discovered melanopsin ganglion cells. This latter cell is intrinsically photosensitive and is important in circadian rhythms and pupillary responses and its behaviour is increasingly being understood, in a large part through the pioneering work of Hankins himself. This opening article in this series is a wonderfully accessible and topical discourse, and lays the foundation for what we will certainly be a highlight in the forthcoming issues.

What do you do with the “incidental” finding of an asymptomatic unruptured intracranial aneurysm? This important question, which is the case in 1 in 40 of us, is posed by Peter Whitfield in his article in the Neurosurgical Management series. The answers are to be found in his article which covers the difficulties in studies addressing such a controversial issue. The main message which comes out of this work is that the rupture rates are higher with posterior circulation and bigger aneurysms but that a large number of factors need to be considered in individual cases. As to what you do with the symptomatic aneurysm turn to the journal reviews... which reminds me to say thanks to Lucy Jones who is moving on and has decided to step down from writing journal reviews for us. If you would like to take her place, let us know.

Mike Dilley, in the rehabilitation article, discusses the neuropsychiatric problems seen in the range of patients on the neurorehabilitation wards, which includes patients with strokes, traumatic brain injury, MS as well as “functional” illnesses (see Sharpe et al ACNR 4.6). This carefully crafted article lays out the clinical features and problems with practical advice on their management, and is an extremely helpful summary of a complex area.

The first in another new series also appears in this issue.We will be discussing techniques in neuroscience - edited by our very own co-editor, Alasdair Coles. In this opening article Alastair Wilkins deals with immunohistochemistry - a technique which has its origins in the 1970s when monoclonal antibodies were first made and being used to label specific epitopes. This technique has now become routine for much experimental and clinical work and Alastair takes us through the principles with illustrations of its power. Whilst being a relatively straightforward technique, many will have experienced the fickle nature of the procedure during the course of their research.

The sponsored article takes as its theme sleepiness and fatigue in MS. This is a major problem with 70% of MS patients complaining of fatigue and 50% sleep related issues. In this article, Mike Boggild and John Thorpy discuss the distinction between fatigue and excessive sleepiness and their underlying aetiological causes and thus their optimal management.

The conference reviews include a thoroughly absorbing account by Sarah Tabrizi and Susie Henley on the recent WCN HD meeting in Manchester as well as a wonderfully entertaining, yet educational, account by Andrew Larner on the EFNS in Athens. A must read, as the nuggets of neurological knowledge are nicely interspersed with a range of amusing observations.

Finally there are the usual journal and book reviews and don’t forget the web site with its clinical cases - including new ones on limbic encephalitis (see ACNR 5.4) and abnormal eyelid movements in a patient with alpha coma following a cardio-pulmonary arrest.

Roger Barker
Roger@acnr.co.uk