Time — A Fourth Dimension for Encephalopathies

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Abstract
The effects of metabolic insults to the developing nervous system are usually related to the etiologic agent, the severity of the disease, and the age at which the insult occurs. There is a fourth dimension, often neglected — the length of time over which the insult takes place.In this issue of the Journal, Msall and Newburger and their colleagues1 , 2 discuss the adverse effects of metabolic encephalopathies in infancy and early childhood on neurologic development and intelligence. The subjects are seemingly unrelated. Msall et al. document the devastating effects that hyperammonemic coma occurring in the first days of life . . .