Lesions of ascending dopaminergic pathways induce neglect in animals. Apomorphine, a dopamine receptor agonist, decreases the magnitude of neglect in rats with cortical lesions. We treated two patients with 15 mg of bromocriptine daily for 3 to 4 weeks, one with chronic (longer than 6 months) and one with relatively more acute disabling neglect. Tests for neglect that significantly improved on therapy and worsened after its withdrawal included line, letter, and geometric figure cancellation tasks. Neither patient noted any untoward effects. Based on this open trial of dopamine agonist therapy in humans with neglect, larger controlled studies may be warranted.

Fasciculations and cramps may occur in motor neuron disease or as part of a more benign syndrome. A man with apparently benign fasciculations and cramps for 4 years developed progressive muscle weakness and wasting. Such a previously undocumented evolution of benign fasciculations and cramps to motor neuron disease may further implicate anterior horn cell dysfunction in the pathogenesis of muscle fasciculation-cramp syndromes.

Antibiotic usage has rendered neurosyphilis uncommon, and cerebral gummas are rare. Reduced awareness of cerebral gummas and abolition of serologic screening can delay diagnosis of this treatable disease. Diagnostic confusion between syphilitic and nonsyphilitic cerebral mass lesions can be increased by apparent resolution of a gumma during steroid therapy. Such an occurrence in a young woman emphasizes the need for serologic testing for syphilis in diagnosing cerebral mass lesions. A trial of conservative therapy using penicillin (with or without prednisone) should be considered for patients with intracerebral mass lesions and positive serologic findings.

December 2, 1983. She was followed closely and remained well for about seven weeks, when she developed fever, headache, nausea, and vomiting. CT scan suggested recurrence of hydrocephalus. Ventricular CSF showed encapsulated budding yeast on india ink preparation. The capsule stained with mucicarmine. The peritoneal specimen and all CSF specimens grew C. neoformans, serogroup ND. Following removal of the shunt and treatment with amphotericin B (0.3 mg per kilogram of body weight per day) and 5-fluorocytosine (1 50 mdkg per day) for six weeks, her symptoms resolved and she remains well and no longer requires a shunt.Peritoneal fluid yielded positive results using all three kits, but CSF and serum specimens were consistently negative.