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Substance abuse may lead to acute or chronic injuries to the spinal cord or PNS in addition to injuries caused by trauma and infection. The most widespread of these conditions are the chronic myopathy and chronic peripheral neuropathy of alcoholism. Less common, but more striking, illnesses attributed to substance abuse include ATM, a subacute myeloradiculoneuropathy resembling combined systems disease, Guillain-Barré syndrome, plexitis, fulminant axonal neuropathy, and acute myoglobinuria with or without severe weakness. If the cause of such syndromes is not otherwise evident, careful probing may reveal a possible causal substance abuse history. Publicity about an imputed association may sometimes (as in inhalant abuse) change the behavior of persons at risk and prevent more cases.

Clinical services must monitor hospital-acquired morbidity, but what rates are expected specifically for neurology inpatients is not evident from published studies. We studied prospectively 1317 consecutive admissions to a neurology service in a university-affiliated city hospital from 1987 to 1990 and recorded all nosocomial infections, nosocomial pneumonia, and decubitus ulcers of stage III or IV. Over the 3-year period, 6.8% of patients had > or = 1 nosocomial infection (and almost half of these had a nosocomial bloodstream infection); 3.1% had > or = 1 case of nosocomial pneumonia; 1.2% developed severe decubitus ulcers, and 8.4% had one or more of the three complications. The incidence of nosocomial infection exceeds that expected from multihospital studies. How much of the excess is peculiar to neurology patients and how much can be attributed to factors in our community and at our hospital cannot be determined from this study. Furthermore, our statistics are not meant as norms, but as initial estimates for quality assurance.

We wrote a list of descriptive phrases to dichotomize admissions to a neurology service by a priori perceptions of risk of death within 30 days as "higher than average" versus "lower than average." In 500 consecutive admissions, the higher-risk list carried a 17-fold relative risk of death for the 20% of admissions so classified. The list is a valid and informative predictor of 30-day outcome that supports a classification of deaths as "expected" or "unexpected."

The validity and reliability of a scoring system for 'neurological soft signs' in teenagers was assessed. Six scales were adapted and fitted into the framework of a conventional neurological examination. The following emerged: each of the three multi-item scales had high internal consistency; inter-rater agreement on mirror movements of 'live' subjects was satisfactory; ratings of videotapes agreed among examiners for mirror movements and dysdiadochokinesis but not for choreiform movements; data-based cut-off scores defining present vs. absent were congruent with the ratings of outside neurologists; and each examiner was consistent in rating mirror movements and rapid alternating movements from videotapes over several months.

To assess 'soft-sign' persistence and its correlates outside a referred sample, 159 members of a local birth cohort of the United National Collaborative Perinatal Project were traced and their performance on six neurological test scales was measured at age 17 by examiners blind to their status at age seven. A comparison group was also formed, who had been 'sign-free' at age seven. On four of the six tests (dysdiadochokinesis, mirror movements, dysgraphesthesia and motor slowness) index boys did significantly worse than the comparison boys; by contrast, index girls scored significantly worse than comparisons only on motor slowness.

Previous surveys of stroke populations have offered only cursory information on language disturbance, and, conversely, few surveys of aphasic populations have dealth exclusively with stroke or with acute phenomena. This paper describes aphasia in 850 acute stroke patients consecutively registered by the Harlem Regional Stroke Program, of whom 177 (21%) were aphasic; of these, nine were of Broca's type, 24 were of Wernicke's type, 14 were of anomic, ten were conduction, seven were of "isolation" type, and 107 were "mixed." An unexpected finding was a significant over-representation of men among the nonfluent aphasics. During the following four to 12 weeks, 12% of fluent aphasics died, and 12% remained moderately or severely impaired; among survivors, aphasia improved in 74%, and in 44% it cleared completely. During the same period, 32% of nonfluent aphasics died, and 34% remained moderately or severely impaired; among survivors, aphasia improved in 52%, and in only 13% did it clear completely. In both fluent and nonfluent groups, hemiparesis and/or visual field cut were associated with poor prognosis.

The course of seizures was reviewed in all 306 residents of Rochester, Minnesota who had epilepsy diagnosed between 1935 and 1978, lived in the region greater than or equal to 5 years after diagnosis, and had an electroencephalogram (EEG). The life-table probability of having achieved 5 years seizure-free (FYSF) by 20 years after diagnosis was 75%. In a multivariable proportional hazards model, these three variables predicted a significantly higher rate of achieving FYSF: no early-life brain damage (remission rate ratio = 2.27, p less than 0.01), no generalized epileptiform activity (rate ratio = 1.58, p less than 0.05), and never having had a generalized tonic-clonic seizure (rate ratio = 1.4, p less than 0.05). The same three variables, plus age at diagnosis, were descriptors of the rate of reaching FYSF off medication. Gender, family history, type of seizure, and EEG findings other than generalized epileptiform activity were not significantly related to either end point. The predictor set did 15% better than prior probabilities in forecasting FYSF. Although informative about group experience, these predictors are weak clinical discriminators, singly or in a set. FYSF occurred in high proportion of even those persons whose history, clinical examination, or EEG findings placed them in a less favorable stratum of one or more predictors.

A review of 850 acute unselected stroke cases at Harlem Hospital found only 25 (3%) who met a clinical definition of pure motor hemiparesis. Compared to other cerebral infarction survivors, the 23 pure motor syndrome survivors were slightly younger, not much more often hypertensive and did not make a faster recovery. The degree of motor deficit a year later was nearly the same in both groups. Brain scans were positive in one-third of the pure motor patients, which suggests that this clinical picture may be associated with larger brain lesions than had been suspected before, as well as with lacunar infarction.

Fifty-nine patients with amyotrophic lateral sclerosis participated in a 12-month, double-blind crossover trial. The patients were given either levamisole 150 mg or placebo in identical tablets once a week orally, and a rating of neurologic signs and symptoms was recorded on monthly visits. The patients were crossed over at 6 months. Levamisole had no effect on the rate of score decline in the 20 patients who completed the trial.