In this population of critically ill patients, propofol is an effective and safe alternative for sedation, with some advantages, such as short duration of action and high effectiveness over the conventional regimen with benzodiazepines and opiates.

In this report, we present the clinical and pathological details of a kindred of four individuals with a novel missense mutation (V272A) of the presenilin 1 gene (PSEN1) that experienced a subcortical dementia. The age of onset of symptoms ranged 26-36-year old, with an age at death of 36-46 years. Initial symptom was a marked mood disorder, with prominent parkinsonism in one case. The neuropsychological study, as well as the neuroimaging and PET in the proband were concordant with a subcortical dementia. The cerebral pathology showed in this patient, aside from the classical lesions of Alzheimer disease, Lewy bodies in cortex and substantia nigra, and widespread subcortical neuritic lesions. This clinical pattern and pathology expands the clinical spectrum of familial Alzheimer's disease and compel to include mutations of PSEN1 gene in the genetic study of subcortical dementia.

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In this study, rat models of wound closure by first and second intention were developed to evaluate the influence that two immunosuppressants for treating multiple sclerosis (fingolimod, azathioprine) have on wound healing. Sixty‐three Sprague‐Dawley rats were daily treated with fingolimod (0.6 mg/kg), azathioprine (2.5 mg/kg), or placebo (saline). Following 6 weeks of treatment, a linear incision (1.5 cm) or a circular excisional defect (diameter 1.5 cm) was made on the dorsal skin. The treatments were uninterrupted and after 7 days (incisional) or 21 days (incisional, excisional), animals were euthanized (n = 7 per group and time‐point). Morphometric (wound closure), histological (stainings), and immunofluorescent studies (macrophages) were performed to evaluate the healing process. For both the incisional and excisional defects, animals treated with fingolimod exhibited a healing process equivalent to that of placebo in terms of collagenization, wound closure, and macrophage response. By comparison, groups treated with azathioprine displayed a delay in healing times which was especially evident in the excisional defect, where inflammatory reaction and collagen deposition in the repair tissue remained active by day 21. These results show that immunosuppressants with a selective mechanism of action (fingolimod) can have less impact on wound healing than their classical nonselective counterparts (azathioprine).

Twenty-four hours after surgery for acute aortic dissection, a 51-year-old man with alcoholism developed agitation, decreased consciousness, mutism, and upbeat nystagmus on upward gaze. He also showed left-sided weakness with pyramidal signs and spastic limb ataxia. After 4 weeks treatment with thiamine supplementation, his neurologic and general condition improved. MRI findings are shown in the figure.Marchiafava Bignami disease is associated with chronic alcoholism and nutritional deficiency. 1,2 Although etiopathogenesis is unknown, alcohol toxicity and osmotic disorders are in relation with typical corpus callosum demyelination. Other CNS structures such us white matter tracts and middle cerebellar peduncles may be involved, but far less frequently.S. Bellido, MD, I. Navas, MD, M.A. Aranda, MD, R. Ginestal, MD, B. Venegas, MD, Madrid, Spain Author contributions: Dr. Bellido: drafting/revising the manuscript, study concept or design, analysis or interpretation of data. Dr. Navas: drafting/revising the manuscript, study concept or design, analysis or interpretation of data. Dr. Aranda: drafting/revising the manuscript, study concept or design, analysis or interpretation of data. Dr. Ginestal: drafting/revising the manuscript, study concept or design, analysis or interpretation of data. Dr. Venegas: drafting/revising the manuscript, study concept or design, analysis or interpretation of data.The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures. This article, along with others on similar topics, appears in the