Twelve patients with episodes of acute confusional migraine (ACM) are reported. Prolonged agitation and mental confusion characterized the headache attacks, occurring mostly among adolescents. The ictal EEG showed diffuse, slow abnormalities and a peculiar pattern known as FIRDA (frontal intermittent rhythmic delta activity). Neuroradiologic examinations and laboratory tests were unremarkable. After the acute stage, EEG gradually tended to show normalization. Apart from the noticeable similarities to the "juvenile head trauma syndrome", the authors assume that ACM represents a peculiar clinical form among the different types of migraine associated with disorders of higher mental functions.

In order to study the role of platelets in Multiple Sclerosis (MS) we assessed, in a group of patients during a quiescent phase of the disease, the plasma levels of beta-thromboglobulin (beta-TG) and platelet factor four (PF4) both in absence of treatment and during administration of aspirin (ASA) at the dose of 50 mg/daily. In the MS patients studied, the basal plasma levels of beta-TG and PF4 were significantly higher than in control subjects. The increase in the beta-TG plasma levels occurred independently of the age, sex and severity of the disease, whereas the modification in the PF4 plasma levels was significantly correlated with the severity of the disease. Administration to the patients of ASA, at the dose that does not affect prostacyclin production, determined a decrease of beta-TG in 77% of the patients. Mean PF4 plasma levels remained unchanged. These results suggest that PF4 in the plasma of MS patients may originate not only from the platelets but also from the mast cells following platelet aggregating factor (PAF) stimulation and immunocomplex formation.

SUMMARY Although platelet activation is known to occur during migraine attacks, the cause-effect relationship remains to be determined. This problem was approached by studying the possible occurrence of platelet activation in vivo in headache-free periods of subjects affected by common or classic migraine and, subsequently, by verifying the possibility of its pharmacological control through administration of a classic anti-aggregation drug such as aspirin (ASA). The plasma levels of beta-thromboglobulin 03-TG) and platelet factor 4 (PF4), indices of the occurrence of platelet activation in vivo, were therefore first assayed in both groups of migraine sufferers in the absence of therapy and then during the administration of aspirin (50 mg/daily).In the group of IS patients affected by classic migraine, basal plasma levels of /3-TG and PF4 were significantly higher than control subjects. On the other hand, only /3-TG plasma levels were significantly higher in the group of 18 patients affected by common migraine. Patients suffering from classic migraine showed a high incidence of platelet activation (>90%) in comparison with common migraine patients (-33%). This suggests that platelet activation occurs in vivo in migrainous patients also during headachefree periods.Administration of aspirin to the patients affected by common and classic migraine caused a decrease in plasma /3-TG and PF4 concentration. Consequently, pharmacological treatment with aspirin in adequate dose may prove to be helpful in diminishing the vascular side-effects known to occur in migraine sufferers.

SUMMARY The clinical, neuropsychological and neuroradiological features of two patients affected by herpes simplex virus type I (HSV-1) encephalitis are described. An experimental study for the assessment of naming, recognition and description displayed in one patient a persistent significant impairment in naming living things. The other patient showed a failing "semantic memory" for the same categories, although a significant impairment emerged only for plants. In both patients, the late neuroradiological sequelae were localised mainly in the inferior and middle gyri of the left temporal lobe and in the left-side insula. In one patient, the right-side insula was also involved. The selective cerebral damage induced by HSV-1 is stressed and a correlation between the neuroradiological and neuropsychological findings is attempted. The stereotyped anatomical and neuropsychological changes lead to the belief that the virus may recognise, within the limbic system, particular cellular "strains" on the basis of their molecular specificity.Encephalitis caused by type 1 herpes simplex virus (HSV-1) is still a severe disorder, although its mortality rate has dropped from about 70% with placebo or inefficacious drug therapy"2 to about 40% with vidarabin3 and about 20% with acyclovir.4 As a result, an increasing number of patients now recover from the disease but are left with neurological sequelae ranging from severe dementia with markedly disturbed behaviour to mild impairment of memory and speech. Occasionally, however, some patients do appear to recover completely.The two patients reported here had an excellent recovery of the higher cortical functions, although anomia in one case and an impairment of semantic memory in the other persisted. In both cases the sequelae involved such semantic categories as animals and plants.Categorisation and, consequently, the formation of "concepts" is one of the primary cognitive processes in man. Concepts play an important role in cognitive processes, as they allow humans to deal with objects Address for reprint requests: Dr Viadimiro Pietrini, Department of Neurology, "San Bortolo" Hospital, 36100 Vicenza, Italy.Received 9 October 1987 and in revised form 5 April 1988. Accepted 11 April 1988 and events even when there is no concrete referent for them. Concepts are "stored" and can be "retrieved" and "expressed" as part of an organisation which is based on semantic categories, or general concepts.It is not our purpose to discuss philosophical and psychological principles underlying the organisation of categories. We merely point out that selective deficits for certain semantic categories have been reported in some patients without all other categories being affected as a result. The first study conducted on a large series of 135 aphasic patients5 showed a high incidence of dissociation for six semantic categories, namely body parts, actions, objects, colours, letters, and numbers. In the last 10 years, category deficits have been studied extensively by Warrington and Shallice, who b...

Platelets are known to be activated in common or classic migraine both during the attack and in headache-free periods. Platelet behavior is less well known in cluster headache. We have investigated beta-thromboglobulin (beta-TG) and platelet factor four (PF4) plasma levels, markers of in vivo platelet activation, in patients during remission and during bouts of cluster headache with and without pain. The results indicated that statistically significantly higher levels of beta-TG and PF4 occur in the patients during the remission period when compared with the control subjects. Such high levels seemed to persist between paroxysmal episodes in cluster periods. However, during the attacks of cluster headache beta-TG and PF4 plasma levels decreased by 42% and 50%, respectively, in comparison with plasma concentrations measured outside of attack. Thus, although platelet activation also occurs in patients with cluster headache, the attack as such seems to be characterized by a marked reduction in platelet activation.