Microbleeds are small areas of haemorrhage which can be easily detected using gradient echo MRI scanning. David Werring, in his excellent review article, describes the possible pathogenesis of these abnormalities and also discusses their significance in different clinical settings – for example, do they predict the risk of haemorrhage in stroke patients receiving an antithrombotic agent? In addition the lesions can produce their own clinical syndrome such as cognitive dysfunction and given how frequently they are seen on MRI, it is clear that this is an area that will be of increasing significance in the future with our aging population.

The complexities of the immune system are so bewildering that it is a wonder we don’t all have some form of autoimmune disease. In her review in the Immunology Primer series Vicki Robertson takes us through the history and function of regulatory T cells, or Tregs to immunologists! This carefully constructed article highlights how this field has recently developed and the extent to which abnormalities in this system have devastating consequences including MS.

The Neurosurgery series discusses spinal metastases and “despite there being class 1 evidence supporting the role of surgery in the context of spinal metastases, the management decision is often not clear cut”. This is the conclusion that Catherine Gilkes and Tim Germon draw for us in their informed account of what is a very difficult area of neurological practice.

The patient who requires a long term tracheostomy often creates a great deal of anxiety for the patient, career, family and medical personnel involved with their care. However the development of multi-disciplinary tracheostomy teams has greatly eased these worries and Claire Scase takes us expertly through the assessment and process by which a patient with a tracheostomy can be successfully transferred and monitored in the community.

The development of unrelated medical problems in patients with persistent vegetative state (PVS) raises many issues on best management. In this issue of the ACNR, we have a sensitive and informed discussion of just such a situation in a young patient who developed Cushing’s disease in the context of their PVS. Advice on the management of such cases is given and is a helpful guide to those who may find themselves in similar situations.

Neurology and literature feature heavily in this issue of the ACNR with Andrew Larner presenting the third in his series on headache. Alastair Wilkins (the ACNR case report coordinator) discusses the works of Proust and especially his great work “À la Recherche du Temps Perdu”. This classic work has many fans and in his article Alastair explores why this book may be relevant to neurology in the 21st Century and in so doing raises question about whether the reading of such works of literature should be compulsory for all aspiring neurologists.

We also have the second in our series of patient perspectives, with David Pickin explaining what it was like to be given the diagnosis of Parkinson’s diesease in his early 40s and how he has dealt with it for over 30 years.

We also have all our usual items, including a sobering report on the management of MS in India. We hope you enjoy this new issue of the ACNR and if anyone would like to contribute to any of our regular journal, book or conference review series then do let us know.

Roger Barker
Roger@acnr.co.uk