Lyme disease of the central nervous system is relatively rare, although not uncommonly considered in the differential diagnosis of patients with an array of neurological problems including facial palsies and a radiculitis. In this clear article by Unn Ljøstad and Åse Mygland, we are taken through the common clinical features of this condition and how it can be diagnosed. This article contains a couple of really useful tables summarising the main points, which overall makes for an extremely succinct, up to date account, of this condition.

Jone Furland Owe and Nils Erik Gilhus discuss an unusual aspect of myasthenia gravis – namely how it affects the heart. They conclude that “There is good evidence for myocardial pathology in MG patients, including a diversity of heart-reactive autoantibodies and focal inflammation with cellular infiltrates and myocardial necrosis. On the other hand, any firm clinical correlates to these findings have yet to be established”. Interesting.

On the theme of epilepsy, Paul Johns and Maria Thom discuss in our neuropathology article the relationship between hippocampal sclerosis (HS) and epilepsy. It is well known that the two are associated but it is not clear whether one causes the other. In this article, the competing theories are discussed in particular whether seizures, especially early in life, cause HS or whether HS is consequent to a developmental problem which then causes seizures.

Plaha and colleagues in their article for the Neurosurgery series consider chronic subdural haematoma. They begin by discussing how such lesions come about and how the patient may present, before considering how to optimally treat it. An issue that is far from clearcut! This is an easy to read account which represents a measured and pragmatic approach to this relatively common neurological problem.

Michael Turner reports on the guidelines and stipulations for jockeys engaged in different types of horse racing and the consequences to them of a fall and a head injury. This is not an uncommon event as there are approximately 110,00 rides a year and “Amateur jockeys fall every 7.9 rides, Jump jockeys fall every 15.8 rides and Flat jockeys fall every 200-250 rides. It is therefore not surprising that horse racing has some of the highest rates of injury seen in any sport, including the highest rates of concussion and fatal accidents in the published literature. Concussion rates are in fact six times greater than in Australian Rules Football – the sport with the closest incidence of concussion.” I think I will continue to walk and ride my bike.

In the first of our new series on Neuroradiology edited by Justin Cross we are treated to a sumptuously illustrated account on CT. In this first article by Justin we are introduced to the Compston effect and Hounsfield Units as well as having partial volume effects explained. This is a wonderful article that gives just the right amount of background physics and technical detail whilst also illustrating the role and value of this imaging modality to neurological practice in 2008.

In our Neurology and Literature series, Dr Pearce takes us through the Charles Bonnet syndrome and how it came to be called this and what exactly is meant by it. This article with a liberal sprinkling of original quotations from Dr Bonnet follows on from the earlier article we featured by Dominic Ffytche in ACNR 4.2 on visual hallucinations and optical illusions.

Heather Angus-Leppan gives us a picture of where the ABN is going (as opposed to where it has come from (see ACNR 7.5).We are also pleased to announce that Heather will be joining the editorial team of ACNR, helping to keep us abreast of developments within the ABN. Finally we have all our usual journal, conference and book reviews. Do enjoy and if you would like to become a part of the reviewing team just let us know by email to Rachael@acnr.co.uk

Roger Barker
Roger@acnr.co.uk