The study provides evidence that hemicraniectomy as treatment of severe space occupying ischemic brain edema saves lives and results in good quality of life in a high proportion of patients, especially in the young. This conclusion is restricted by the lack of a control group, which was deemed unethical in studying a potentially life saving therapy.

Objective-To determine: (1) patterns of cognitive and psychiatric dysfunction; (2) those neurobehavioural parameters which mostly influence disability in activities of daily living (ADL) and handicap in occupational and psychosocial activities, and (3) underlying neuroanatomical pathology in patients after rupture and repair of anterior communicating artery (ACoA) aneurysm. Methods-30 patients were extensively examined by means of a comprehensive battery of neuropsychological tests, by rating of psychopathological symptoms, and by use of the functional independence measure (FIM), Glasgow outcome scale (GOS), and MRI. Results and conclusions-(1) Three main groups were characterised by primary impairment of memory, executive functions, or of attentional performance. Within these main groups, specific patterns were identified relating to extent of primary dysfunction and associated disorders. The variety of neuropsychological disturbances is in contradiction to the existence of an "ACoA syndrome" as an entity. (2) Rehabilitation outcome proved to be mostly associated with both memory and attentional performance. (3) In neuropathological terms, lesions of the medial septum and nucleus of the diagonal band of Broca (MS/ndbB) were closely associated with memory deficits and prefrontal lesions were associated with attentional, executive, and psychopathological dysfunctions. At the same time, bilateral lesions were associated with severe disturbances. The type and severity of the above mentioned deficits were independent of the side of lesion in unilateral cases, of rectus gyrus resection, and of the Hunt and Hess grading system. (J Neurol Neurosurg Psychiatry 1998;65:93-102)

Neurological deterioration is frequent in anterior choroidal artery infarcts and is associated with worse outcome. While mechanisms of small and large vessel disease seem to overlap in anterior choroidal artery infarction, we were not able to identify predictors of neurological progression.

Dear Sir, Osteoathropathic alteration is a major cause of morbidity in patients with severe haemophilia. During infancy and adolescence, prophylaxis is undoubtedly preferable to on-demand therapy, but as yet poor data exist comparing the onset of prophylactic treatment at an early age with treatment initiated at a more advanced age (1,2,3). In order to determine which therapy regime is needed to prevent haemophilic arthropathy we prospectively compared 17 patients with moderate and severe haemophilia A (age: 3-14 years; mean age: 6 2/12 years). All 17 patients were treated with factor VIII (30-40 IU/kg bw/three times per week; Humate P®, Beriate HS®, Behring, Germany). Prior to radiological and clinical examinations of the knee, elbow and ankle joints patients were subdivided into two groups according to therapy regimes. In group 1 prophylactic treatment was initiated in