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This ESC Council on Stroke/EAPCI/EBNI position paper summarizes recommendations for training of cardiologists in endovascular treatment of acute ischaemic stroke. Interventional cardiologists adequately trained to perform endovascular stroke interventions could complement stroke teams to provide the 24/7 on call duty and thus to increase timely access of stroke patients to endovascular treatment. The training requirements for interventional cardiologists to perform endovascular therapy are described in details and should be based on two main principles: (i) patient safety cannot be compromised, (ii) proper training of interventional cardiologists should be under supervision of and guaranteed by a qualified neurointerventionist and within the setting of a stroke team. Interdisciplinary cooperation based on common standards and professional consensus is the key to the quality improvement in stroke treatment.

Purpose To investigate the association between exposure to head computed tomography (CT) and subsequent risk of meningioma. Materials and Methods The study was approved by the local ethics committee. A cohort of 26 370 subjects was retrospectively collected from a radiology archive of CT examinations of the head performed from 1973 through 1992. For comparison, an age- and sex-matched cohort of 96 940 subjects who were not exposed to CT (unexposed cohort) was gathered. The risk of meningioma was assessed by using data from the Swedish Cancer Registry; however, one-third of patients with meningioma had to be excluded because they either had a prevalent meningioma or other brain tumor at the first CT examination or had undergone radiation treatment to the head. Hazard ratios (HRs) were calculated from time of exposure to the occurrence of meningioma or death or until December 31, 2010, with logistic regression. Results Comparison of exposed and unexposed cohorts showed that there was no statistically significant increase in the risk of meningioma after exposure to CT of the head (HR: 1.49; 95% confidence interval: 0.97, 2.30; P = .07). If incident cases at the time of the first CT examination were not excluded, the risk of meningioma would have been falsely increased (HR: 2.28; 95% confidence interval: 1.56, 3.33; P = .0001). Conclusion When prevalent cases of meningioma at first exposure to CT of the head are excluded, no statistically significant increase in risk of meningioma was found among exposed subjects compared with unexposed control subjects.

PURPOSE The aim of the present study was to seek evidence of a relationship between damage to the optic radiation (OR) in the immature brain and subsequent development of the retinal nerve fiber layer (RNFL) and associated visual manifestations. METHODS Seven cases (2 males and 5 females ranging in age from 18 to 35 years old) were selected from a large cohort of individuals with known white matter damage of immaturity (WMDI), who had presented with visual dysfunction. They underwent magnetic resonance imaging (MRI), including diffusion-weighted MRI. Visual function was evaluated by best-corrected visual acuity and visual field (VF) testing using Goldmann perimetry and Humphrey field analyzer (HFA). RNFL thickness was measured by optical coherence tomography. RESULTS A homogeneous lesion pattern with bilateral WMDI predominantly in the superior posterior periventricular white matter was seen in all subjects. However, as shown by white matter fiber tractography, only cases with injuries to the superior portion of the OR had corresponding inferior VF defects. In the individuals showing structural abnormalities in the OR, a commensurate reduction in the peripapillary RNFL was seen. The RNFL loss was most pronounced in the subjects suffering from the more extensive lesions, and it followed the pattern of OR damage in the sense that damage in the superior portion of the OR gave a reduced RNFL thickness in the superior part of the peripapillary RNFL. CONCLUSIONS Primary injuries in the immature OR are associated with reduced RNFL thickness, and examination of the RNFL may be a helpful predictor of VF defects.

BACKGROUND AND PURPOSE: Diffusion-weighted MR imaging and fiber tractography can be used to investigate alterations in white matter tracts in patients with early acquired brain lesions and cerebral palsy. Most existing studies have used diffusion tensor tractography, which is limited in areas of complex fiber structures or pathologic processes. We explored a combined normalization and probabilistic fiber-tracking method for more realistic fiber tractography in this patient group. MATERIALS AND METHODS: This cross-sectional study included 17 children with unilateral cerebral palsy and 24 typically developing controls. DWI data were collected at 1.5T (45 directions, b=1000 s/mm2). Regions of interest were defined on a study-specific fractional anisotropy template and mapped onto subjects for fiber tracking. Probabilistic fiber tracking of the corticospinal tract and thalamic projections to the somatosensory cortex was performed by using constrained spherical deconvolution. Tracts were qualitatively assessed, and DTI parameters were extracted close to and distant from lesions and compared between groups. RESULTS: The corticospinal tract and thalamic projections to the somatosensory cortex were realistically reconstructed in both groups. Structural changes to tracts were seen in the cerebral palsy group and included splits, dislocations, compaction of the tracts, or failure to delineate the tract and were associated with underlying pathology seen on conventional MR imaging. Comparisons of DTI parameters indicated primary and secondary neurodegeneration along the corticospinal tract. Corticospinal tract and thalamic projections to the somatosensory cortex showed dissimilarities in both structural changes and DTI parameters. CONCLUSIONS: Our proposed method offers a sensitive means to explore alterations in WM tracts to further understand pathophysiologic changes following early acquired brain injury.

The development of interventional neuroradiology (INR) has increased rapidly during the past few years. A majority of cerebral aneurysms today are treated using more and more sophisticated endovascular techniques dedicated to the different types of aneurysms (fusiform/saccular, large and giant/small, wide neck/small neck, ruptured/unruptured). Also, endovascular techniques for the treatment of acute ischemic stroke are increasingly being used with highly effective results, particularly in the management of large-vessel occlusions, whereas angioplasty and stenting have a significant place in the prevention of stroke by treating cervical and intracranial stenoses. INR is the principal technique for the treatment of intracranial and spinal dural arteriovenous fistulas and also plays a significant role in the management of brain and spinal arteriovenous malformations, as well as in the presurgical embolization of cranial and spinal hypervascular tumors and in the devascularization of patients with, for example, epistaxis. Although the creation and development of INR were initiated by neuroradiologists, other medical specialists have become progressively more involved with the techniques, particularly neurosurgeons and, to a lesser extent, neurologists. Because it was a new medical practice, no specific medical training was initially available but, over time, several scientific societies began to propose guidelines for the training and practice of INR.1,2 Until now, training in INR has been a matter between trainee and teacher and, thus, the result has often been less-than-optimal training with a long learning curve, with patients paying a high price. The Union Europeenne des Medecins Specialistes (UEMS)/European Union of Medical Specialists) is the officially recognized and permanent consulting nongovernmental organization for European medical institutions; today it represents 35 national organizations and ≈1.6 million medical specialists. The UEMS is involved in professional issues important to European specialists and has a significant influence on how these issues are formulated in the directives and laws …

Background. Much variation is found in the development of hand function in children with unilateral cerebral palsy (CP). Objective. To explore how anatomic brain abnormalities can be used to predict the development of hand function. Methods. A total of 32 children with unilateral CP (16 boys and 16 girls) were evaluated at least once a year by the Assisting Hand Assessment (AHA). The data collection covered an age range from 18 months to 8 years (mean time in study, 4 years and 6 months). Computerized tomography or magnetic resonance imaging of the brain were assessed for patterns of brain damage, including the location of gray and extent of white-matter damage. The children were divided into groups according to lesion characteristics, and a series of univariate models were analyzed with a nonlinear mixed-effects model. The rate and maximum limit of development were calculated. Results. The highest predictive power of better development of hand function was the absence of a concurrent lesion to the basal ganglia and thalamus, independent of the basic type of brain lesion. This model predicted both the rate of increasing ability and hand function at age 8 years. Hand function was also predicted by the basic pattern of damage and by the extent of white-matter damage. The presence of unilateral or bilateral damage had no predictive value. Conclusions. Neuroradiological findings can be used to make a crude prediction of the future development of the use of the affected hand in young children with unilateral CP.

The energy absorbed from the radio-frequency fields of mobile telephones depends strongly on distance from the source. The authors' objective in this study was to evaluate whether gliomas occur preferentially in the areas of the brain having the highest radio-frequency exposure. The authors used 2 approaches: In a case-case analysis, tumor locations were compared with varying exposure levels; in a case-specular analysis, a hypothetical reference location was assigned for each glioma, and the distances from the actual and specular locations to the handset were compared. The study included 888 gliomas from 7 European countries (2000-2004), with tumor midpoints defined on a 3-dimensional grid based on radiologic images. The case-case analyses were carried out using unconditional logistic regression, whereas in the case-specular analysis, conditional logistic regression was used. In the case-case analyses, tumors were located closest to the source of exposure among never-regular and contralateral users, but not statistically significantly. In the case-specular analysis, the mean distances between exposure source and location were similar for cases and speculars. These results do not suggest that gliomas in mobile phone users are preferentially located in the parts of the brain with the highest radio-frequency fields from mobile phones.

(CP). METHOD Visual field function was assessed using the confrontation technique and Goldmann perimetry in 29 children (15 males, 14 females; age range 7‐17y, median age 11y) with unilateral CP classified at Gross Motor Function Classification System (GMFCS) level I and Manual Ability Classification System levels I to III. The type and extent of brain lesions were determined using cerebral imaging. RESULTS Eighteen children had subnormal visual field function. The visual fields were severely restricted in six. The underlying brain lesions were malformation (n=7), white matter damage of immaturity (WMDI; n=13), and cortical‐subcortical lesions (n=9). Visual field function could be correlated with the pattern of brain damage in children with cortical‐subcortical lesions or extensive lesions caused by malformation or WMDI. Total homonymous hemianopia was common in the cortical‐subcortical group but rare in children with malformation or WMDI. Five children had normal visual field function despite having malformation or WMDI involving parts of the brain usually encompassing the visual system. INTERPRETATION Visual field function may be preserved by plasticity of the immature brain in children with malformation and WMDI. Severely restricted visual fields were more often associated with lesions occurring later in the developing brain. All children with severely restricted visual fields were identified by the confrontation technique. Goldmann perimetry was a suitable method to identify relative visual field defects. The cerebral lesions in children with cerebral palsy (CP) often involve parts of the brain that contain the posterior visual system (geniculate body, optic radiation, occipital cortex). Thus, visual field function may be affected in children with CP. Visual field function can be mapped using various techniques and the results expressed as the outer limits of the visual field, i.e. the furthest points at which an individual can see a strong and large stimulus, or, as the sensitivity with which an individual is able to see a small and weak object in the central field. Procedures in which a white ball is moved from the periphery towards the fixation line, with or without an arc perimeter, are referred to here as confrontation techniques, and can be used to identify the outer limits of the visual field. Goldmann perimetry is a manual perimetry technique in which changes in the size and intensity of a stimulus are used to detect relative visual field

Purpose: White matter damage of immaturity may affect visual, motor and cognitive functions. This multiple-case study presents standardized perimetry results in six teenagers and young adults born prematurely with visual dysfunction due to white matter damage of immaturity of pre- or perinatal origin. Methods: Six subjects, aged 13–25 years, born at a gestational age of 28–34 weeks, with white matter damage of immaturity documented by MRI, and optic disc appearances documented by fundus photography, were examined with manual and computerized quantitative perimetry. Results: All subjects had subnormal visual field (VF) function, although the depth and extension of the VF defects differed between subjects. The inferior VF function was more deviant than the superior in all cases. The concordance between the VF defects detected with the different techniques was good, although the static computerized techniques revealed slightly more abnormality. Conclusion: White matter damage of immaturity may affect the VF. The lower VF is often more affected than the upper. The abnormalities can be demonstrated by both manual and computerized perimetry.

The suggested link between autism and cerebellar dysfunction formed the background for a Swedish clinical study in 2001. Thirty-two children (17 females, 15 males; mean age 12y, SD 3y 10mo; range 6 to 21y) with a clinical suspicion of non-progressive congenital ataxia were examined, and parents were interviewed about the presence of neuropsychiatric problems in the child. Twelve children had simple ataxia, eight had ataxic diplegia, and 12 had 'borderline' ataxia. All but one of the 32 children had a mild to moderate gross motor disability according to Gross Motor Function Classification System (15 were categorized as level I, 16 as level II, and one child as level IV). Neuroimaging and neuropsychological testing were achieved in most cases. There was a strong association between learning disability* and autism spectrum disorder (often combined with hyperactivity disorder) on the one hand, and both simple and borderline 'ataxia' on the other, but a weaker link between ataxic diplegia and neuropsychiatric disorders. A correlation between cerebellar macropathology on neuroimaging and neuropsychiatric disorders was not supported. Congenital ataxia might not be a clear-cut syndrome of cerebellar disease, but one of many signs of prenatal events or syndromes, leading to a complex neurodevelopmental disorder including autism and learning disability.

Preterm birth frequently involves white matter injury and affects long-term neurologic and cognitive outcomes. Diffusion tensor imaging has been used to show that the white matter microstructure of newborn, preterm children is compromised in a regionally specific manner. However, until now it was not clear whether these lesions would persist and be detectible on long-term follow-up. Hence, we collected diffusion tensor imaging data on a 1.5-T scanner, and computed fractional anisotropy and coherence measures to compare the white matter integrity of children born preterm to that of control subjects. The subjects for the preterm group (10.9 +/- 0.29 y; n = 9; birth weightor= 1500 g; mean gestational age, 28.6 +/- 1.05 wk) possessed attention deficits, a common problem in preterms. They were compared with age- and sex-matched control children (10.8 +/- 0.33 y; n = 10; birth weightor= 2500; gestational age,or= 37 wk). We found that the preterm group had lower fractional anisotropy values in the posterior corpus callosum and bilaterally in the internal capsules. In the posterior corpus callosum this difference in fractional anisotropy values may partially be related to a difference in white matter volume between the groups. An analysis of the coherence measure failed to indicate a group difference in the axonal organization. These results are in agreement with previous diffusion tensor imaging findings in newborn preterm children, and indicate that ex-preterm children with attention deficits have white matter disturbances that are not compensated for or repaired before 11 y of age.

Purpose To determine the causes of visual impairment in a population-based group of visually impaired preterm children. Methods Ophthalmological examination and magnetic resonance imaging or computed tomography of the brain were performed in all visually impaired preterm children born 1989-95 in Varmland. Results Ten of 18 children had periventricular leukomalacia affecting the optic radiation, six had other lesions or malformations in the posterior visual pathways/cortex, but no child had visually impairing retinopathy of prematurity. Conclusion We conclude that cerebral lesions or malformations are common causes of the visual functional deficit in visually impaired children born preterm. Brain damage should be suspected in a prematurely born child who presents with either of the signs: fixation difficulties, strabismus or nystagmus.

Objective To characterise pregnancies where the fetus or neonate was diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial haemorrhage (ICH), with special focus on time of bleeding onset. Design Observational cohort study of all recorded cases of ICH caused by FNAIT from the international No IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010. Setting 13 tertiary referral centres from nine countries across the world. Participants 37 mothers and 43 children of FNAIT pregnancies complicated by fetal or neonatal ICH identified from the NOICH registry was included if FNAIT diagnosis and ICH was confirmed. Primary and secondary outcome measures Gestational age at onset of ICH, type of ICH and clinical outcome of ICH were the primary outcome measures. General maternal and neonatal characteristics of pregnancies complicated by fetal/neonatal ICH were secondary outcome measures. Results From a total of 592 FNAIT cases in the registry, 43 confirmed cases of ICH due to FNAIT were included in the study. The majority of bleedings (23/43, 54%) occurred before 28 gestational weeks and often affected the first born child (27/43, 63%). One-third (35%) of the children died within 4 days after delivery. 23 (53%) children survived with severe neurological disabilities and only 5 (12%) were alive and well at time of discharge. Antenatal treatment was not given in most (91%) cases of fetal/neonatal ICH. Conclusions ICH caused by FNAIT often occurs during second trimester and the clinical outcome is poor. In order to prevent ICH caused by FNAIT, at-risk pregnancies must be identified and prevention and/or interventions should start early in the second trimester.

Response: We thank Lee et al1 for their interest in the European Union of Medical Specialists (UEMS) Training Charter for Interventional Neuroradiology (INR). Setting standards for training where none exist can be perceived as controversial because it may imply that previous training has been insufficient or needs to be improved in one way or another. Assembling training charters, including detailed curricula defining the content of a training program, is an important task within any specialty; it is in fact so important that UEMS is using the training curriculum as the definition of a specialty. Whether there is a need to expand the number of specialists within a specialty or not is not the issue, when training guidelines are nonexistent. The important issue is to define the body of knowledge and formulate a curriculum that is accepted by those practicing the specialty. In doing so, the first priority must be patient safety, whereas professional issues, such as prestige and more or less open turf battles, must be of a lower priority. This training charter in INR is also the first such document which has been prepared and approved conjointly by representatives from all …

UEMS—European Union of Medical Specialists—is alobby and consulting organisation representing physicianstrained in a medical speciality in all those countries that aremembers of the European Union—EU.UEMS is organised in sections, each medical specialityrepresented by a section. To have a section in UEMS isequal to being a recognised medical speciality in Europe.There are sections of radiology, neurosurgery and neurol-ogy, just to mention a few pertinent specialities. TheSection chairmen are members of a General Assembly ofUEMS and the Council of UEMS is the executivecommittee of the organisation.TheCouncilofUEMStook,forEuropeanNeuroradiology,a very important decision in Bratislava on October 12th 2007when it approved the proposal of organising a “Division ofNeuroradiology”. This was unanimously supported by theUEMS Section of Radiology when it met in Vienna duringECRinMarchof2008.InaninauguralmeetinginBrusselsonSeptember 13th 2008, the “Division of Neuroradiology” wasformed. The officers of the Division were elected and as thefirst President of this division Professor Olof Flodmarkfrom Stockholm was elected. Professor Massimo Galluccifrom Italy was elected as General Secretary and ProfessorPeter Barsi of Hungary as Treasurer. Neuroradiology is, tothis date, the only division formed within the“family” ofRadiology.It has been a long sought goal for Neuroradiology tobecome represented in UEMS and to be recognised as adefined body of knowledge, speciality or at least as a superspeciality within the family of Radiology. The process thatended with the inauguration of the Division of Neuroradiol-ogy into UEMS in September 2008 started in the ExecutiveCommittee of European Society of Neuroradiology—ESNR—in the year of 1998. At this time neurology showeda significant interest in including Neuroradiology as asubspeciality of clinical Neurology [1]. The same year aproposal from ESNR to EAR, European Association ofRadiology, to allow Neuroradiology to be represented inUEMS within the family of Radiology, was turned down.Professor Pierre Lasjaunias wrote in 1998 and 1999, duringhis presidency of ESNR, the first documents outlining aproject with the outline of training in Neuroradiology [2]andlater the expressed goal of making Neuroradiology repre-sented in UEMS. Professor Lasjaunias wrote: “It is nowcrucial for our specialty to be actively represented togetherwith neurology and neurosurgery at the UEMS.” [3]Thework continued in several seminars during the presidency ofOlof Flodmark and in January 2002, the European Board ofNeuroradiology—EBNR—was formed.EBNR was deliberately formed on the pattern of asection of UEMS in order to create an organisation thatwould be possible to transform, with as little effort aspossible, into a section or division of UEMS. Thus EBNRestablished committees for accreditation, audit, certifica

White matter damage of immaturity may affect visual, motor and cognitive functions. This multiple-case study presents standardized perimetry results in six teenagers and young adults born prematurely with visual dysfunction due to white matter damage of immaturity of pre- or perinatal origin.Six subjects, aged 13-25 years, born at a gestational age of 28-34 weeks, with white matter damage of immaturity documented by MRI, and optic disc appearances documented by fundus photography, were examined with manual and computerized quantitative perimetry.All subjects had subnormal visual field (VF) function, although the depth and extension of the VF defects differed between subjects. The inferior VF function was more deviant than the superior in all cases. The concordance between the VF defects detected with the different techniques was good, although the static computerized techniques revealed slightly more abnormality.White matter damage of immaturity may affect the VF. The lower VF is often more affected than the upper. The abnormalities can be demonstrated by both manual and computerized perimetry.

Objective: To examine the development of reading skills among very-low-birthweight (VLBW) children and to what extent reading difficulties at 9 years of age persist unchanged, are attenuated, or are enhanced at 15 years of age. Methods: Fifty-six VLBW and 52 normal birthweight (NBW) children were assessed on word decoding, word recognition, and reading comprehension at 9 and 15 years of age. Results: VLBW children showed deficits in reading skill at 9 years of age, while most differences obtained at 15 years of age did not reach significance. VLBW children improved their reading comprehension between 9 and 15 years of age more than NBW children, and when controlling for individual differences in IQ, VLBW children improved both their reading comprehension and word-recognition skill. Conclusion: The results suggest that VLBW children display positive changes over time in reading skills. © The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved.

Hypoxic-ischemic encephalopathy (HIE) is graded with three levels of severity-mild, moderate and severe. The outcome of individuals with mild and severe grades can be reliably predicted from this scheme. Individuals with moderate degree are divided in outcome between those who suffer major neurologic problems (e.g., cerebral palsy) and those who are assumed to recover from the incident. It is however not clear if the recovery is complete and unquestionable. A group of adolescents who had been born at term, diagnosed with moderate HIE but had not developed cerebral palsy, were investigated with diffusion tensor imaging. Fractional anisotropy maps were used as a basis of comparison to a group of controls of the same age and gender distribution. In several white matter areas fractional anisotrophy was lower in the group of individuals with a history of moderate HIE. These areas include the internal capsules (bilaterally in the posterior limb and on the right in the anterior limb), the posterior and anterior corpus callosum as well as frontal inferior white matter areas. These results indicate that even in the absence of such major neurologic impairments as cerebral palsy, moderate HIE causes long term white matter disturbances which are not repaired by adolescence.

Purpose: To characterise the nature and degree of ocular disorders and cerebral morphological and functional abnormalities in a population-based group of visually impaired full-term pre-school children. Methods: Forty-five children who were born at full-term between 1989 and 1995 in Varmland, Sweden, were reported as being visually impaired. An ophthalmological examination was performed and clinical data regarding mental development and neurological disease were obtained for all children. Cerebral imaging was performed in 35 children, Results: Twenty-six per cent of the children were found to have ocular disorders only. Forty-two per cent had cerebral morphological abnormalities, verified by cerebral imaging, and 65% had signs of cerebral functional abnormalities. In total, 74% were found to have cerebral morphological and/or cerebral functional abnormalities. Conclusion: The majority of children with visual impairment, including children with ocular disorders, were found to have cerebral morphological and/or cerebral functional abnormalities. We suggest that any child with visual impairment should therefore undergo cerebral imaging and be examined by a paediatrician in order to establish the correct diagnosis. (Less)

Nancy, To : Members of WFNRS Presidents National Societies of Neuroradiology Individual Members of National Societies of Neuroradiology The World Federation of Neuroradiological Societies — WFNRS — was originally conceived by Prof. Derek Harwood-Nash and was established in 1993. The mission statement reads: WFNRS is an umbrella organization composed of 25 national and regional neuroradiological societies. It fosters international saentific and educational programs in neuroradiology and promotes cooperative projects between its member organizations and those in allied disciplines. This mission statement is held in very general terms and can be claimed to be non-committing! It is almost 20 years since the WFNRS was established and Radiology and Neuroradiology in particular, has seen a breathtakingly quick technical development not only in our discipline but also in the society in general. Internet and the advent of rapid data communications have redrawn the map and completely changed the conditions for an organisation like WFNRS. Although the social aspects of a scientific meeting can not be underestimated, the traditional way of communicating experiences and scientific ideas during large and small scientific meetings and courses is not fast enough and new types of meeting places are established every day. The WFNRS has an organisation and particularly a constitution of the past and has yet to take the step into the 21st Century. Whether we like it or not, radiology as a single discipline is unlikely to survive. Future neuroradiologists will probably not need to have general radiology training. Thus it will be necessary to reform the training of neuroradiologist into becoming a neuroscientist with an imaging profile with or without competence in endovascular treatment. It will be necessary to reorganise future departments of radiology in order to support organ or disease process oriented work flow with distributed equipment localised close to the patient and in an intellectual environment with organ-specialised clinicians of various profiles. The nature of neuroradiology today is not a specialty focused on producing an ever increasing number of examinations and reports but rather a clinical specialty in which the neuroradiologist can have an intellectual exchange of knowledge and skills providing added value to patient care with his or her particular competence in imaging interpretation and minimally invasive treatment as applied in patients with diseases of the central nervous system. This is the challenge of the new decade and the early parts of the 21st Century! It is this understanding of our future that must guide the activities of the WFNRS the next decade. We should not be in the business of arranging courses or meetings. There are other organisations far better equipped and proficient in these tasks. We should not think that we can have a leading role in research or providing networks for exchange of scientific news. This is done anyway! It is for this reason that the outgoing and incoming presidents of the WFNRS has agreed to present the following program for the next four years. It is to realise this program that we ask your approval 1. The future of WFNRS we believe is to a significant degree in cyber space. We are convinced that the most important mode of communication with a world wide membership is over internet. 2. We plan to use the funds remaining from previous contributions to develop a web-site of WFNRS. 3. We propose a nominal fee for society membership in WFNRS for the coming two years — USD 50.00 for annual membership 2010-2011 4. We will perform an inventory of those training charters available in different parts of the world. These charters will be made available on the web-site 5. This inventory should be used to formulate WFNRS guidelines about training in diagnostic and interventional neuroradiology 6. We propose that WFNRS will prepare and formulate Technical and Professional Guidelines in other areas such as: a. Continuing medical education/continuing professional development b. Quality assurance c. Accreditation of training centres d. Good medical care in neuroradiology e. Good standard of practice in interventional neuroradiology f. Postgraduate training — examination 7. Support subspecialisation within neuroradiology a. Support preparation of Technical and Professional Guidelines b. Invite subspecialisation societies to join WFNRS 8. Provide a discussion forum for the future of neuroradiology a. Future training of neuroradiologists b. Relationship with neuro science c. Foster exchange of ideas within neuroscience d. Future training of neuroscientists with imaging profile It is our conviction that WFNRS could play an important role in the coming decade provided that the activities of the Federation "add value" to the membership societies, and their members. Should we fail in this concept, and you are the judges about our success, it is possible that the world of neuroradiology would do well without a World Federation. Sincerely yours Luc Picard President WFNRS Olof Flodmark President Elect WFNRS

MR COMPATIBLE INCUBATOR AND QUIET IMAGING SEQUENCES FOR THE EXAMINATION OF NEWBORN INFANTS 29

Eight children with clinical and radiologic abnormalities consistent with periventricular leukomalacia were investigated with MR imaging of the brain that employed both inversion-recovery and T2-weighted spin-echo imaging sequences. The more precise delineation of white and gray matter on inversion-recovery images as compared with CT allows a detailed demonstration of the anatomic features of periventricular leukomalacia; specifically, a reduced quantity of white matter in the periventricular region and centrum semiovale and, in more severe cases, cavitated infarcts that replace the immediate periventricular white matter. The T2-weighted spin-echo and short inversion time inversion-recovery images demonstrated abnormally increased signal in white matter that appeared normal on CT scans and only minimally abnormal on conventional inversion-recovery images. These abnormalities most probably represent white matter gliosis that extends beyond the immediate periventricular regions. MR recognition of cerebral white matter abnormalities associated with periventricular leukomalacia may confirm the clinical suspicion of this diagnosis in children with spastic diplegia or quadriplegia.

Fifty patients with permanent cortical visual impairment were evaluated. They had a characteristic behaviour profile, usually with residual sight but poor visual attention. 30 of the 50 also had damage to the anterior visual pathway. Visual evoked potential mapping was shown to have a clear advantage over visual evoked responses, and using that in conjunction with CT and clinical data enabled several subgroups of cortical visual impairment to be identified. The diagnosis probably is more common than previously recognised, and should be suspected when there is greater delay in visual development in other areas and the degree of visual loss is unexplained by ocular findings. Using traditional criteria for cortical blindness may mean that many children are not diagnosed, which has serious implications for their rehabilitation.

BACKGROUND/AIMS—Periventricular leucomalacia (PVL) is a lesion in the immature brain involving the optic radiation. Children with PVL have visual problems including crowding, visual field defects, strabismus, and visual perceptual/cognitive deficits, together with nystagmus. They often have optic nerve hypoplasia seen either as small discs or as large cupping of normal sized optic discs. This study aimed to perform eye movement recordings in a group of children with PVL in order to characterise and classify the nystagmus. METHODS—19 children with PVL on cerebral imaging underwent eye movement recordings with the Ober-2 infrared reflection technique. RESULTS—16 of the 19 subjects had horizontal nystagmus. CONCLUSION—The present study shows that nystagmus is commonly seen in children with PVL. Keywords: nystagmus; periventricular leucomalacia; visual impairment; cerebral imaging; eye movement; infrared reflection technique

Aims: To evaluate the relation between optic disc morphology and timing of periventricular white matter damage, defined as either periventricular leucomalacia (PVL) or periventricular haemorrhage (PVH), as estimated by neuroradiology. Methods: 35 children with periventricular white matter damage who had had neuroradiology performed and ocular fundus photographs taken had their photographs analysed by digital image analysis and compared with a control group of 100 healthy full term children. Timing of brain lesion was estimated by analysis of the brain lesion pattern on neuroradiological examinations (magnetic resonance imaging or computed tomography). Results: Four of 35 children had a small optic disc area; these four children had a brain lesion estimated to have occurred before 28 weeks of gestation. Nine of 11 children with a large cup area had a PVL/PVH estimated to have occurred after 28 weeks of gestation. The children with PVL/PVH had a significantly larger cup area (median 0.75 mm 2 ) than the control group (median 0.33 mm 2 ) (p = 0.001) and a significantly smaller neuroretinal rim area (median 1.58 mm 2 ) than the controls (median 2.07 mm 2 ) (p = 0.001). Conclusion: In a child with PVL/PVH and abnormal optic disc morphology, the possibilities of timing of the lesion should be considered.