Acute weakness associated with West Nile virus (WNV) infection has previously been attributed to a peripheral demyelinating process (Guillain-Barré syndrome); however, the exact etiology of this acute flaccid paralysis has not been systematically assessed. To thoroughly describe the clinical, laboratory, and electrodiagnostic features of this paralysis syndrome, we evaluated acute flaccid paralysis that developed in seven patients in the setting of acute WNV infection, consecutively identified in four hospitals in St. Tammany Parish and New Orleans, Louisiana, and Jackson, Mississippi. All patients had acute onset of asymmetric weakness and areflexia but no sensory abnormalities. Clinical and electrodiagnostic data suggested the involvement of spinal anterior horn cells, resulting in a poliomyelitis-like syndrome. In areas in which transmission is occurring, WNV infection should be considered in patients with acute flaccid paralysis. Recognition that such weakness may be of spinal origin may prevent inappropriate treatment and diagnostic testing.

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Carbamazepine (CBZ) has a long history of successful use in epilepsy and, therefore, has a safety profile that is well characterised. Additionally, an extended-release formulation of CBZ (CBZ-ERC; Equetro, Shire US) has recently been approved for use in bipolar disorder. The most frequent adverse events associated with CBZ are somnolence, fatigue, dizziness and headache. Rash and leukopoenia may occur in approximately 10% of patients, but are benign and transient in most cases. Rare serious adverse effects include agranulocytosis, aplastic anaemia, Stevens-Johnson syndrome and toxic epidermal necrolysis. Although changes in lipid profiles have been noted, hyperglycaemia does not occur with CBZ, and clinically significant weight gain is uncommon. Proper monitoring and careful titration of the extended-release formulation should allow for successful use of CBZ in psychiatric patients.

The recent American adaptation of Luria's approach, called the Luria-Nebraska Neuropsychological Battery (LNNB), is designed so that all 269 of its items must be asked of each patient. The present study investigated whether the LNNB items could be arranged in a decision-tree fashion that would allow item administration based on the patient's performance. In the initial experiment, results from 40 standardly administered LNNB, (full-LNNB) were compared with derived results based on the decision-tree administration procedure (decision-LNNB), and it was found that the decision-LNNB was in 91% agreement with full-LNNB scale scores above the brain-impaired cutoff line. Furthermore, using Golden's two-scale elevation rule, the two administration procedures were in 100% agreement in selecting brain-impaired patients. In the second experiment, the decision-LNNB was used alone with 26 brain-impaired patients and 4 normals and was found to have an 87% hit rate, which is comparable to previous reports of the full-LNNB's accuracy. The experiments also revealed that the decision-LNNB allowed the omitting of 76 items, on the average, when used with a sample of brain-impaired and normal subjects.

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