“What you do on finding an incidental unruptured AVM on scanning is obviously something that causes great concern, both to clinician and patient alike. In the excellent article (and photo) by Rustam Al-Shahi Salman and colleagues, he discusses the evidence (or rather lack of it) for the best way to manage these patients, highlighting the fact that there is a new randomised trial on unruptured brain AVMs called ARUBA. This article explains the possible risks of not treating AVMs in terms of haemorrhage, and how this varies according to location and venous drainage. However, the bottom line seems to be that the behaviour and best treatment of these vascular abnormalities is far from clear - lets hope ARUBA gives us the answer.

That MS is an auto immune disease is not doubted, but how it comes about immunologically remains an area of great debate, as Claire Halliwell shows us in her excellent article on T cells. In this account we are introduced to Th17, a new type of T cell which appears to be regulated in part by Th1 and Th2 cells, and may be important in autoimmune disorders such as MS – a disease for which animal modeling has proven controversial. We are therefore fortunate to have David Baker and Samuel J Jackson (not Samuel L Jackson) to take us through these issues with respect to Experimental Allergic Encephalomyelitis (EAE). Both authors are professing ‘EAEologists’ and highlight the point that “EAE is not a single model but a number of models that have varying degrees of similarity to MS”. A very helpful and informative read.

It is hard to believe that it was only 50 years ago that dopamine was fully recognised as a neurotransmitter in the CNS, and that in 1959/1960 it was discovered to be lacking in patients with Parkinson’s disease, by Oleh Hornykiewicz and colleagues. It is therefore an enormous honour to have Professor Hornykiewicz write about this in our series on Living Legends. This vivid account conveys the excitement of the discovery and the reluctance of the established community of the day to fully accept these findings. As with all articles in this series, it is wonderful account that makes one feel very humble.

It is with great pleasure that I announce two new series of articles for the ACNR - one on Neurogenetics edited by Tom Warner and the other personal accounts of disease from patients. In the first of the Neurogenetics series, Tom sought to obtain a leading expert to write for us on Hereditary Spastic Paraplegia. After much searching and deliberating, he chose himself – and as a consequence his article, as one would expect, is a beautiful synthesis of a bewildering complex series of conditions. It combines simple clinical advice (e.g. spasticity is typically much greater than weakness in HSP) with up-todate scientific advances (e.g. the interaction of spastin and atlastin in axonal maintenance) - a great start to what promises to be a terrific series.

In the first of our new series of articles on personal experiences of disease, I am enormously grateful to Claire Rytina (a patient of mine) who eloquently describes the consequences of the herpes simplex encephalitis that struck her back in 2004. This is a truly moving account of how a disease can change your sense of identity, worth and relationships – a theme which is discussed in the book review on Human Traces. The account that Claire relays to us is a remarkable and deeply moving account, which will impact heavily on all those involved in clinical practice.

The most recent ABN case report winner by Matthew Jones and colleagues deals with a unique cause of eosinophilic meningitis in the United Kingdom. The offending organism comes from eating infected snails, who in turn have eaten rat faeces. So beware the next time you see an unusual case of meningitis from one of the areas endemic for
rat lungworm!

We also have all of our usual journal, book and conference reports. We hope that you continue to enjoy the ACNR and do let us know if there is an area of clinical neuroscience or rehabilitation that we should cover

Finally on a sad note, many of you will already know that Professor Ian Mcdonald died suddenley on the 13th December 2006. Professor McDonald had been an inspiration to many neurologists worldwide and his loss is great.

Roger Barker
Roger@acnr.co.uk