I am running on 4 gb or ram, a gts 250 with newest drivers, a athlon 64 x2 7750 proccessor that runs at 2.7 ghz per core (2 cores) on 1280 x 1024 on medium settings without bloom or hdr, and 2 aa 4 af
what can i do to increase fps especially around npc's enemyies and fights? I could run fallout 3 at a stead 70-90 fps, will they do patches for performance soon? or ever? any tips for me? also how do i get rid of the mouse accel

Hm.

Well, your best bang for the buck move would be to get a better video card. The GTS 250 is pretty solid, but if you're running into issues with multiple enemies on-screen, it's the video card. You might think about a beefier processor. Not sure what mobo you're working with, but look at stuff like bus speed and consider getting a faster model. You'd be surprised how much of an impact the motherboard has on performance. More ram never hurts, but 4 gb should be plenty depending on the speed. After that, look at your power supply and make sure everything's getting enough juice. Finally, you might think about your hard drive, maybe getting a faster one or setting up RAID.

No idea about patches in the works, or the mouse accel thing. But yeah, for upgrades, it sort of depends on how much money you're willing to spend. If you only get one thing, I would say get the biggest, nastiest video card you can, and after that look at motherboard/CPU upgrades, then the rest.

Don't be so quick to leap onto the "inadequate hardware" conclusion. I've got a fairly recent win7x64 isntall on an Intel SSD, with a 3.6GHz core 2 quad, and a GTX285 and 8GB of ram -- and I dipped down to 10 FPS during a large firefight, and I don't even have any AA on.

It's likely nvidia/ati will release FO:NV optimized drivers soon, and/or there will be performance patches soon.