A patient (B.J.) is reported who developed severe memory impairment following a penetrating brain injury caused by a snooker cue which entered through his left nostril into the basal regions of the brain. Initially, his memory disorder had the clinical features of a dense amnesic syndrome, with both anterograde and retrograde amnesia, but B.J. subsequently showed significant recovery of memory function. Formal memory testing was carried out 21 months after injury. This demonstrated marked verbal memory impairment, as severe as that seen in patients with the amnesic syndrome. On nonverbal memory tests, his impairment was relatively mild and patchy. His retrograde amnesia had regressed mainly to affect a 6 month period before the injury. On other cognitive tasks, he performed at an average or above average level, and there was no neuropsychological evidence of frontal lobe dysfunction. Neuroradiological investigations at various stages after his injury failed to demonstrate a lesion in any of the thalamic nuclei. Magnetic resonance imaging showed a lesion in the hypothalamus in the region of the mamillary bodies. Our study demonstrates that marked, relatively focal, memory disorder after diencephalic injury can occur without direct pathology to the body of the thalamus. It also indicates that structures in or adjacent to the hypothalamus, such as the mamillary bodies, may play a more important role in human memory functioning than has hitherto been considered.

SUMMARYThe management of 93 patients with craniocerebral gunshot wounds is reviewed. The contrast between the injuries of urban guerilla warfare, conventional warfare and civilian life is outlined. Emphasis is placed on the need for early and adequate transfusion and for immediate airway control to limit cerebral oedema. Principles of wound surgery evolved in other conflicts were followed and developed.CEREBRAL gunshot wounds differ from other types of head injury. The initial damage is often focal; even when both cerebral hemispheres are affected the level of consciousness is often surprisingly light, but spreading cerebral oedema, if unchecked, leads rapidly to severe generalized brain damage.When a bullet strikes the body the effect depends partly on the kinetic energy of the bullet and partly on its size and shape. As kinetic energy is a function of the mass of the bullet and the square of its velocity ( E = +mu2), it follows that even a small high velocity bullet will carry much more energy than a larger one of low velocity. A high velocity bullet travels faster than the speed of sound

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Doubt remains as to the safest surgical approach to the prolapsed thoracic intervertebral disc. Laminectomy, lateral rhachotomy and the transthoracic approach all have their protagonists. Twenty-two patients from the National Hospital for Nervous Diseases, Queen Square, and Atkinson Morley's Hospital have been reviewed. Their clinical presentation is discussed and the ancillary aids to diagnosis assessed. The diagnostic value of disc space calcification is stressed, and the use of air myelography as an adjunct to positive contrast myelography is noted. Fifteen patients were subjected to laminectomy, and seven to lateral rhachotomy. Each group contained patients with a wide range of neurological deficit. Six of the patients who underwent laminectomy were improved, two were unchanged, six deteriorated and one died. Of the patients who had lateral rhachotomy, six were improved, one was unchanged and none deteriorated. The conclusion is drawn that lateral rhachotomy is a safer procedure.