Objective-To assess the survival rate and functional outcome in elderly patients with space occupying supratentorial infarction who underwent hemicraniectomy compared with those who received medical treatment alone. Methods-All patients older than 55 years with space occupying middle cerebral artery (MCA) infarction treated in our clinic between January 1998 and July 1999 were included in this retrospective analysis. Patients were eligible for decompressive surgery if they were younger than 75 and had no severe comorbidity. Hemicraniectomy was performed regardless of the aVected hemisphere. All patients were followed up for assessment of functional outcome; data were assessed according to the Barthel index and modified Rankin scale and cover a period of 3 to 9 months after infarction. Results-Twelve out of 24 patients underwent hemicraniectomy. Eight patients who were operated on survived; only one patient died of transtentorial herniation, three other deaths were due to medical complications. None of the survivors had a Barthel score above 60 or a Rankin score below 4. Nine out of 12 medically treated patients died of transtentorial herniation, one patient died of medical complications. The two surviving patients had a Barthel score below 60 and a Rankin score of 4. Conclusions-Craniectomy in elderly patients with space occupying MCA infarction improves survival rates compared with medical treatment alone. However, functional outcome and level of independence are poor. Craniectomy in elderly patients should not be performed unless a prospective randomised trial proves beneficial. (J Neurol Neurosurg Psychiatry 2001;70:226-228)

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• MRI continues to yield further information concerning MS lesions. • SWI adds diagnostic information in patients with possible MS. • The "central vein sign" was predominantly seen in MS lesions. • The "central vein sign" helps discriminate between MS and non-MS lesions.

Early intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit–risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.

In this study, we analysed the frequency, morphological patterns and clinical characteristics of cerebral ischaemia in bacterial meningitis. We sought to determine predictors for the development of vasculopathy and ischaemic infarction in patients with bacterial meningitis. Consecutive adult patients admitted between March 1998 and February 2009 to a neurological intensive care unit at a university hospital in Germany with the diagnosis of bacterial meningitis were included in the study. Standard criteria were used to define bacterial meningitis. From 68 patients with bacterial meningitis, six patients suffered from cerebral ischaemia (8.8%). In our cohort, reduced level of consciousness on admission (p = 0.01) and lower white blood cell (WBC) count in cerebrospinal fluid (CSF) (p = 0.012) were associated with development of ischaemic cerebrovascular complications. The short-term outcome of all patients was poor (median modified Rankin scale 4.5). In patients presenting with reduced level of consciousness on admission and/or low WBC count in CSF early cerebral imaging including MR angiography or CT angiography are warranted to detect impending cerebrovascular complications.

For analysis of the morphology of the visual field in advanced glaucoma, we tested 62 eyes of 54 late stage glaucoma patients using program 10-2 on the Humphrey Field Analyzer. The fields, which were already reduced to a small central isle, had mostly typical, asymmetric borders with their largest extend to the temporal lower quadrant and their smallest extend to the upper nasal quadrant. An upper nasal step was very frequent. The boundaries are equivalent to the retinal nerve fiber lines. Actually, the glaucomatous isle is a 'centro-coecal isle', representing a remnant of intact maculo-papillary nerve fiber bundles. A test with a 2 degrees spacing like the Humphrey program 10-2 proved to be useful for routine perimetry in these cases.

The so-called 'nerve fiber bundle defects' in the visual field are considered as being the functional equivalent of retinal nerve fiber bundle damage. This study examines the course and the position of scotoma borders in 159 visual fields with complete nerve fiber bundle defects using high resolution test point patterns. The scotoma border lines were averaged geometrically. The result is presented in the form of mean vectors. This functional map of nerve fiber lines shows a close correspondence to the anatomical course of the retinal nerve fibers. To make the result suitable for topographical analysis of visual fields, 21 areas ('Perimetric Nerve Fiber Bundles') are defined. Certain arbitrary assumptions were necessary because data were to scanty in some nasal regions. Also, the lines had to be fitted into a rectangular grid to be transferable to standard perimetric patterns. Topographical analysis on the basis of these areas may be useful for the evaluation of visual fields, particularly those of glaucoma.