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Arachnoid cyst with choroid plexus.

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career goals have been irrevocably determined to an area of
investigation for a sufficient period, and at an adequate
intensity, to make the experience worthwhile in itself, and
to attract able young minds to the field.
While I agree that the relatively low proportion of research grants awarded to clinical neuroscientists is a matter
of concern, it would be inappropriate to consider making
awards on grounds other than scientific merit. I believe that
only by training a cadre of highly competent clinical scientists can we correct the present situation and maintain our
commitment to scientific excellence.
Neurological Clinical Research
the Senate and House committees. (The current “torchbearer” is David Daly, MD, who has continued to carry out
this thankless but essential assignment with effect and quiet
That the “old days” are gone and that the attitude of the
nation toward the health profession has changed drastically
can’t be denied. The lead article in the January 7, 1978,
issue of Suturduy Review, entitled “The Great Health Care
Rip-off,” is eloquent testimony to this unfortunate development. It is long overdue that both neurological
societies, all the lay societies (“Gentle Legions”), the medical schools, as well as neurologists in individual or group
practice combine their efforts in the field of neurological
research. It may not be too late, but “time’s a wastin’.”
Stephen Stolzberg, M D
As a full-time clinician, I found the editorial on clinical
investigation very interesting since it seems to explain the
fact that most volumes or courses entitled “Recent Advances and/or Progress in Clinical Neurology” have very
little progress to report.
On the other hand, I doubt there is any urban area in the
United States that has a shortage of well-trained clinical
neurologists, yet training programs are graduating clinical
neurologists at the same rate they were ten years ago. I
think it is time the academic neurology departments redirected their energies into clinical research and away from
continued training of clinicians.
Author’s address: Portland Neurological Associates, PC, 2800 N
Vancouver, Portland, OR 97227.
The Public’s View
Charles A. Kane, MD
Though this is not commonly appreciated, it was not the
medical profession, academic or practicing neurologists, or
the medical schools who were responsible for the origin
and continued funding of the National Institutes of Health
or the original National Institute for Neurological Diseases
and Blindness (NINDB). Rather, it was an aroused public,
spurred by such individuals as Mary Lasker, a few farsighted neurologists, for example, A. B. Baker, MD, and
especially genuine “friends of MedicineINeurology“ in
the Congress, such as Senator Lister H
ill and Representative John Fogarty (both deceased) who struggled valiantly
against immense inertia to foster the “birthing” and nurture
of the institutes. From this modest beginning the National
Citizens Committee for the Neurological Sciences arose,
coordinating the diverse, often conflicting interests of the
many lay societies with the budgetary needs of NINDB as
seen by its director and staff. Early in this process, the
contributions of the American Academy of Neurologyinitially standing virtually alone for the neurosciences-can
be pointed to with pride. Among other things, “principal
(civilian) witnesses” appeared regularly before the Congress, interpreting the needs of the neurosciences to both
From the Division of Neurology, Kaiser-Permanenre Medical
Center, Hayward, CA 94545.
Public Support
Frank M. Yatsu, MD
I applaud Dr Plum’s much-needed comments on the crisis
facing neurological clinical investigation. As a member and
now Chairman of the Neurological Program Project Committee, I have sadly wimessed the erosion of clinical investigation by the process he outlines.
Lost support for the “innovative tinkerer or gifted dilettante,” implying an untutored genius, is indeed regrettable,
but the foundation of quality clinical research must rest
upon a bedrock of rigorous science. To this end, support
for postdoctoral training must receive high priority to ensure the steady and enlightened flow of creative investigators. Thus, increased funding for highly publicized
competitive TIAs and RCDAs available in larger numbers
is a necessary long-term commitment of the NINCDS.
N o question that in the final analysis the direction and
allocation of funding become a public mandate, an expression of our legislative process. The political reality is that
the pivotal role in the decision-making process is played by
congressional committees, all of which respond to pressure
groups, special interests, and lobbyists. Though still fragmented in its thrust, neurology has grown up to this reality
and now needs leadership to provide the push (and maybe
From the Department of Neurology, University of Oregon Health
Sciences Center, Portland, OR 97201.
Arachnoid Cyst with
Choroid Plexus
Ellsworth C. Alvord, Jr, MD, and Cheng-Mei Shaw, MD
The case report by Rosich-Pla et al on a congenital
“arachnoid cyst” (Ann Neurol 2:443-446, 1977) presents
the intriguing problem of how choroid plexus could be
present in a cyst composed only of leptomeninges.
From the Department of Pathology, University of Washington
School of Medicine, Seattle, WA 98195.
Assuming that the plexus was not a “floater” artifact, we
would funher assume that the cyst had some cerebral
ependymal component, as Rand et a1 first described in “Intracranial Telencephalic Meningoencephaloceles” (J Neuropathol Exp Neurol 23:293-305, 1964) and as we
recently reviewed in the differential diagnosis of congenital
arachnoid cysts (‘Congenital arachnoid’ cysts and their differential diagnosis, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology, vol 31, pp 75-135, 1977).
Is the Right Hemisphere
Malvin Cole, MD
LeDoux et al refer to the right hemisphere as the “mute
half-brain’’ and “silent inhabitant of the right side of the
cranium” [5]. Setting aside the dextral patients with right
hemisphere language dominance, although these patients
may have theoreacal implications [ 11, not all authors agree
that the right half-brain in a dextral patient is always or
From the Department of Neurology, Memorial Hospital of Nat-
rona County, Casper, WY 82601.
5 6 4 Annals of Neurology
Vol 3 No 6 June 1978
even usually completely mute. Jackson, for example, considered that both hemispheres are involved in speech but that
the left one is the “leading” hemisphere for voluntary or
propositional speech, whereas the right one subserves automatic ejaculatory speech [3]. Gowers and others discussed patients who, after a left hemisphere lesion, became
aphasic and reacquired speech only to lose it after a fresh
right hemisphere lesion [Z, 41. Many contemporary papers
raise the question of language function in the right hemisphere. I t would seem that the right half-brain is subservient to the left in language but may, in its own way and at
certain times, have its own say.
1. Ettlinger G, Jackson CV, Zangwill OL: Dysphasia following
right temporal lobectomy in a right handed man. J Neurol
Neurosurg Psychiatry 18:214-217, 1955
2. Gowers W R A Manual of Diseases of the Nervous System.
London, J & A Churchill, 1888, vol2, p 103
3. Jackson JH: Notes on the Physiology and Pathology of Language, in Taylor J (ed): Selected Writings of John Hughlings
Jackson. New York, Basic Books, 1958, vol 2, p 125
4. Kinsbourne M: The minor cerebral hemisphere as a source of
aphasic speech. Arch Neurol25:302-306, 1971
5 . LeDoux JE, Wilson DH, Gazzaniga MS: A divided mind: observations on the conscious properties of the separated hemispheres. Ann Neurol 2:417-420, 1977
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arachnoid, choroid, plexus, cysts
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