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Arch Neurol. 1998;55:445-446.

STROKE 1998
Stroke and Recombinant Tissue-type Plasminogen Activator
Intravenous recombinant tissue-type plasminogen activator administered within 3 hours of symptom onset followed by heparin had a significant beneficial effect in 10 of 12 patients with vertebrobasilar ischemic stroke. Grond et al (SEE ARTICLE) provide encouraging results with this acute, combined form of therapy. An editorial by Caplan (SEE ARTICLE) and a neurological review by Adams (SEE ARTICLE) provide essential perspectives on this study.

Natural History of Vertebral Artery Disease
Wityk and colleagues (SEE ARTICLE) present the results of their analysis of the New England Medical Center Posterior Circulation Registry and describe their experiences with patients' occlusive disease of the proximal (V1) segment of the vertebral artery. Their findings are highly significant by virtue of describing the longitudinal natural history of disease in this subgroup of patients with posterior circulation ischemia. Occlusive V1 disease is an important and highly treatable condition.

Predicting Outcome in Stroke
Predicting the neurologic outcome of patients with stroke is difficult and risky. Yamamoto et al (SEE ARTICLE) provide specific criteria indicating probable outcomes of patients with a variety of different types of acute stroke. Clearly, this approach has value in the treatment of patients with acute and serious forms of cerebrovascular disease.

¹H-MR Spectroscopy and Stroke Predictions
Biochemical, noninvasive analysis of patients with acute stroke using single-voxel localized proton magnetic resonance spectroscopy (¹H-MRS) has predictive value in patients with stroke. Reduced levels of N-acetylaspartate and elevated levels of lactate result in an unfavorable neurologic outcome. Preserved N-acetylaspartate levels and no lactate signal correlated with a good recovery. Magnetic resonance spectroscopy is earning its place at the bedside, as presented by Federico and colleagues (SEE ARTICLE) .

Seeing NF-1
DiMario and Ramsby (SEE ARTICLE) prospectively studied patients with neurofibromatosis type 1 (NF-1) with MRI and followed the evolution of T₂ lesions over time. Lesions changed in size and in total number of specific regions, providing greater insight into the biological behavior of lesion formation in NF-1.

Leptomeningeal Cancer
Leptomeningeal spread of non–small cell lung cancer is a desperate clinical circumstance. Chamberlain and Kormanik (SEE ARTICLE) studied 32 selected patients and measured the outcome of clinical response to radiation therapy and intraventricular and/or systemic chemotherapy. Mean survival was 5 months despite aggressive therapy, indicating how desperate this matter is.

The GABA A₃ Receptor as a Risk Factor for Multiple Sclerosis
Gade-Andavolu et al (SEE ARTICLE) provide evidence that the -aminobutyric acid A₃ receptor gene (GABRA3) occurs more frequently in patients with multiple sclerosis compared with the other alleles of this gene. They suggest that the effect of the risk factor of this GABRA3 gene may be mediated through its regulation of prolactin release.

Autoimmunity and Multiple Sclerosis
Patients with multiple sclerosis with autoimmune features, including antinuclear antibodies and/or antiphospholipid antibodies, were studied and compared with patients with multiple sclerosis who do not show evidence of these autoimmune features. Tourbah et al (SEE ARTICLE) found no significant difference between patients with multiple sclerosis free of autoimmune features and "autoimmune" patients (those with such features). Specific clinical criteria were analyzed in detail and provide interesting insights into the autoimmune mechanisms of this common neurologic disease.

Trying to Treat ALS
Riluzole has provided hope for patients with amyotrophic lateral sclerosis (ALS) and the study by Riviere and colleagues (SEE ARTICLE) shows that riluzole treatment provided some benefit in patients by prolonging the early phases of the disorder. Reducing glutamatergic neurotransmission with this agent seems to have modest gains and emphasizes that glutamate cytotoxicity plays an important role in this disease. We need to pay attention to these modest observations and clues in developing future therapy.

Platelets and Alzheimer Disease
Sevush et al (SEE ARTICLE) describe platelet activation with a variety of biochemical parameters in patients with Alzheimer disease compared with appropriate controls. Platelets contain metabolic products of the amyloid precursor protein. The role of platelets in this regard as a marker of the disease or perhaps a contributor to it is reviewed in this interesting study.

Cultural Alzheimer Disease
Binetti et al (SEE ARTICLE) have studied transcultural differences in presenting features of Alzheimer disease is US and Italian patients. Similar patterns were described in both groups, but Italian patients showed a higher mean Neuropsychiatric Inventory Scale score at all levels of dementia. Cultural influences are important in evaluating dementia severity.