ADHD and mania share many symptoms and several pathogenetic aspects. The common belief that stimulants are contraindicated in mania has been challenged, and controlled trials to study the possible antimanic effects of vigilance-stabilizing drugs such as stimulants are justified and necessary.

Little is known about comorbidities of bipolar disorder such as Parkinson's disease. A case history and a literature survey indicate that bipolar disorder is linked with or influences Parkinson's disease and vice versa. Underlying mechanisms are poorly understood, and, more importantly, no treatment options are established in such double diagnoses. The few data in comorbid Parkinson cases seem to point to a rapid cycling pattern of bipolar symptoms. With regard to therapeutic intervention, the literature supports pramipexole for treatment of both Parkinson and depressive symptoms in bipolar depression. Lithium, the mood stabilizer of choice for treating manic states, is problematical for use in Parkinson patients because of its side effects. Valproate might be an alternative, especially for treatment of rapid cycling.

The article reviews the relationship between depressive symptoms and mild cognitive impairment (MCI). Evidence bearing on this relation comes from clinical findings, neuroimaging, and cerebrospinal fluid markers. Depression in elderly people is associated with a higher occurrence of cognitive impairment, whereas the decline of cognitive functions over time seems to be a predictor of the development of dementia. Further symptoms predicting a high risk of progression from MCI to dementia are anxiety, restlessness, and low awareness of cognitive malfunction. There are controversies in the literature, however, about the connections among vascular brain lesions, depression, and MCI. Frontal and temporal brain regions seem to be at the core of functional changes in MCI patients. Several studies of cerebrospinal fluid point out the role of tau protein in predicting the outcome of MCI over time. In conclusion, diagnosis of MCI demands a complex assessment. MCI patients with and without depression need careful follow-up investigations.

A ncient Roman sculpture busts are remarkable for their realistic and relentless portrayals of their subjects. The periods of the Roman Republic and the early Empire before the third century AD were heydays of sculpture that did not hide blemishes or even diseases. Afterwards, the realism of busts was replaced by stylistic features like geometrization and stiffness. 1 The 2 ancient Roman sculpture busts described here are exhibited in the Capitoline Museum in Rome. I point out remarkable features of each bust and discuss possible neurologic diseases underlying these features. This is, of course, speculative because we lack any other supporting information. The first bust of an unknown man (figure 1) is attributed to 1 of 2 sculptors, both named Zenas. The Greek sculptor Zenas came from the art school of Aphrodisias, 2 located near the present city Geyre in Turkey. He worked in the first half of the second century AD, and his name is known only from the inscription on the socle of the bust. The bust dates from the time of Hadrian's reign (117 to 138 AD) and is made of so-called Lunense marble (i.e., marble from Carrara, Italy). The face reveals 2 remarkable features: the deeply lined forehead and a slight ptosis. The edge of the eyelid looms marginally over the pupil. The look of the forehead may be a reaction to the ptosis. The eyelids should be widened by a contraction of the frontalis muscle. The deep lines of forehead skin could be regarded as chronic, and if so, could be caused by a mitochondrial disorder such as Kearns-Sayre syndrome (ophthalmoplegia plus). This would be the case especially if ptosis started before age 20 and was accompanied by neurologic symptoms such as ataxia and spastic, proximal myopathy. Alternatively, an ocular myasthenia is possible. Less likely is progressive supranuclear palsy, described in 1963 by Richardson et al. 3 In this instance, the deeply lined forehead would be an important sign, but in addition the eyelids would be retracted (Cowper sign) so that the patient would look astonished or startled. The second bust (figure 2), from an unknown artist, also originates from the time of the Roman Empire, and is supposed to represent the Greek dramatist Menander (ca. 341-290 BC). Unlike other portrait busts of Menander, which have harmonious facial features, this one has some abnormalities. We know too little about the life or health of Menander to construct a case history. In this bust, it is striking that the pupils are divergent. The man is either looking straight ahead, in which case a left-sided palsy of oculomotor nerve is shown with additional slight ptosis of the left eyelid, or, less presumably, the man is looking left but his right eye may show an adduction paresis, possibly caused by a right-sided palsy of the oculomotor nerve. Despite the shadows on his face, it seems that the left half of his face has less deep lines than the right half. Fachklinikum Brandis, Germany. Funding information and disclosures are provided at the end of the article. Full disclosure form informa...

This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.