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White matter lesions (WML) are a frequent finding on brain magnetic resonance imaging scans. Elevated blood pressure (BP) is consistently identified as risk factor for WML. However, it is unknown whether BP still is associated with WML in patients manifesting vascular disease. The aim of this cross-sectional study was to investigate associations between BP and WML in patients manifesting vascular disease. A total of 1030 patients with vascular disease (cerebrovascular disease (23), coronary heart disease (59), peripheral arterial disease (23), abdominal aortic aneurysm (9)) from the Second Manifestations of Arterial Disease study were included. WML volume was calculated using an automated quantitative volumetric method and subsequently divided into quartiles. We investigated associations between BP and WML and examined whether relations between BP and WML were modified by the localisation of the symptomatic site or presence of diabetes. Participants had a mean age of 58.7 years. Median volume of WML was 1.70 ml. Mean BP was 141/82 mmHg and 69 suffered hypertension. No significant associations between systolic BP, diastolic BP, mean arterial pressure (MAP) or hypertension presence and moderate or large WML volumes were present. The relation between BP and WML was not modified by the localisation of vascular disease or diabetes presence. Among patients manifesting vascular disease, BP was not associated with the presence of WML, irrespective of the presence of diabetes or the localisation of vascular disease.

Abstract: The first case is presented of an exophytic chiasmatic-hypothalamic glioma causing progressive hemidystonia in an 8-year-old boy, and all 24 reported cases of intra-axial cerebral tumours resulting in symptomatic hemidystonia are reviewed.

The value of radiography, ultrasound and magnetic resonance imaging (MRI) in detecting skeletal and intraspinal pathology was assessed in infants with anorectal malformations, and the need for spinal MRI examination in this group of patients was evaluated. Twenty-one infants were examined with radiography, ultrasound and MRI of the lower spine. The detection of skeletal and intraspinal abnormalities was compared for the three imaging modalities. Fifteen patients were normal in all three examinations. Radiography showed bony skeletal abnormalities in six children, although sometimes very subtle. By ultrasound both bony and cartilaginous malformations were detected in all six patients and by MRI in five patients. Five of the six children with skeletal abnormalities had intraspinal pathology, detected in all cases by ultrasound and MRI. However, the abnormalities were more clearly demonstrated by MRI than by ultrasound. Spinal radiographs must be examined carefully for abnormalities, because they can indicate the presence or absence of intraspinal pathology. Normal radiographic and sonographic appearance of spinal anatomy in children with anorectal malformation makes MRI superfluous, but if radiographs or ultrasound are abnormal, MRI should be used to accurately depict possible intraspinal pathology.

Magnetic resonance imaging (MRI) of the brachial plexus and its region has become the imaging modality of choice, due to its multiplanar capabilities and inherent contrast differences between the brachial plexus, related vessels, and surrounding fat. A total of 41 patients with clinically suspected brachial plexus pathology or tumors in its region were studied. A normal anatomy was found in 12 patients. Pathologic entities included: traumatic nerve-root avulsion (n=2), hematoma (n=1), postoperative changes after scalenotomy (n=2), primary tumor of the brachial plexus (n=2), primary (n=8) and metastatic (n=1) tumors in the superior sulcus, primary (n=5) and metastatic (n=4) tumors in the axillary, supra- or infraclavicular region, and changes after nodal dissection and radiation therapy for breast carcinoma (n=5; 1 patient also had had a prior scalenotomy). There was a positive correlation with surgery in 11 patients, and a negative correlation in 1 patient.

Using cardiac-gated fast acquisition with multiple excitation (FAME), time curves of the cerebral aqueduct signals were derived in 19 healthy volunteers and 14 patients. A mean curve of the normal subjects was determined during systole. A relatively stable point of time was found at 270 msec after the R-wave supposed to be the reversal of the flow of cerebralspinal fluid in the aqueduct. Different curves were noticed in complete aqueductal obstruction (n2); in other pathologic states, such as cerebral tumor (n3), normal pressure hydrocephalus (n3), and brain atrophy (n1), no different signal time curves were observed. Parameters such as aqueduct diameter, cerebro-spinal fluid volume and brain compliance are probably other important factors in aqueduct liquor flow.

Marfan's syndrome is a connective tissue disorder, which mainly affects the cardiovascular system, together with ocular, skeletal and connective tissue. The cardiovascular manifestations in particular determine the mortality of this disorder. We studied 13 patients, suffering of Marfan's syndrome, with suspected aortic dilatation by means of magnetic resonance imaging (MRI). Aneurysmal dilatation of the aortic root and dissection were the two major findings in our study. Two of the five patients with dissections presented without relevant symptoms in the medical history nor at the time of the MRI examination.

We studied whether magnetic resonance (MR) imaging of the brachial plexus is useful to distinguish multifocal motor neuropathy (MMN) from lower motor neuron disease (LMND) and whether abnormalities resemble those of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We compared MR images of the brachial plexus of nine patients with MMN with scans from five patients with CIDP, eight patients with LMND, and 174 controls. In two patients with MMN, and in three patients with CIDP, the MR images showed an increased signal intensity on the T2-weighted images of the brachial plexus. Two other patients with MMN demonstrated a more focal, increased signal intensity on the T2-weighted images, occurring in one patient only in the axilla, and in the other patient in the axilla and in the ventral rami of the roots. MR images of the brachial plexus of eight patients with LMND were normal. The distribution of the MR imaging abnormalities corresponded with the distribution of symptoms of the patients: asymmetrical in MMN and symmetrical in CIDP. These findings demonstrate that MR imaging abnormalities of the brachial plexus in patients with MMN resemble those seen in CIDP and may be useful to distinguish MMN from LMND.

A 36-year-old Caucasian woman presenting with persisting painful calves after a flu-like illness was diagnosed as having polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the outer muscle groups with sparing of the central located muscles. The good clinical response to oral prednisone was supported by improvement of MRI.

Several patients have been reported with an asymmetric sensory or sensorimotor demyelinating neuropathy not fulfilling the diagnostic criteria for chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy.