In “Cerebello-spinal tDCS in ataxia: A randomized, double-blind, sham-controlled, crossover trial,” Benussi et al. exposed 20 patients with neurodegenerative ataxia to cerebello-spinal transcranial direct current stimulation (tDCS) and sham stimulation and found that tDCS resulted in significant improvement in performance, motor cortex excitability, and cerebellar brain inhibition. Matsugi speculated that Benussi et al.'s findings demonstrate that spinal-cerebellar functional connectivity is retained in spinocerebellar ataxia and improved with tDCS. He noted that further study into cerebellar brain facilitation and inhibition and spinal direct current stimulation in this patient population are needed. Benussi et al. replied that they believe simultaneous spinal and cerebellar tDCS synergistically improves cerebellar function and spasticity, and agreed that further studies on the distinct and combined effects of cerebellar and spinal tDCS are needed, as stimulation may benefit this patient population for whom no drugs are available. In “Severe hyperhomocysteinemia manifesting as moyamoya vasculopathy and Henoch-Schonlein purpura,” Cho et al. described a 37-year-old woman with a history of Henoch-Schonlein purpura with leukocytoclastic vasculitis and immune mesangiopathic glomerulonephritis who presented with recurrent ischemic infarcts and was found to have hyperhomocysteinemia due to homozygous cystathionine β-synthase (CBS), then developed moyamoya vasculopathy requiring a direct bypass on the left and an encephalo-duro-arterio-synangiosis procedure on the right. The authors suggested that the cerebral, skin, and renal changes are all the result of CBS deficiency. In review of this case, Drs. Gaillard and Arquizan postulate that the underlying mechanism was likely a systemic vasculitis with CNS involvement and question whether (1) inflammatory markers, autoantibodies, and serologies were checked in serum or CSF, (2) a brain biopsy was obtained, or (3) a trial of steroids or immunosuppressants was given. Cho et al. respond that (1) serial cerebral angiograms showed progressive intracranial stenosis consistent with moyamoya vasculopathy, not with vasculitis, and (2) CSF showed no pleocytosis, and inflammatory and infectious tests were negative. They note that there was no recurrence of skin or renal events despite the absence of systemic therapy, making the diagnosis of secondary CNS vasculitis unlikely. While both Cho et al. and Drs. Gaillard and Arquizan agree that the high-resolution MRI was suggestive of vasculitis, Cho et al. believe it is consistent with a moyamoya-like vasculopathy and that this case represents a new phenotype of CBS deficiency.