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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.

Background The question has been raised whether low dose radiation toward the brain in childhood can affect cognitive functions. Purpose To examine if a head computed tomography (CT) examination in childhood affect later cognitive functions. Material and Methods A total of 147 participants (67 girls/women, 80 boys/men) from a previous randomized controlled trial on management strategies after mild head injury (head CT examination or in-hospital observation) were followed up. Participants were aged 6–16 years (mean age = 11.2 ± 2.8) at first inclusion and 11–24 years (mean age = 17.8 ± 2.9) at follow-up. Computerized neuropsychological measures used for the assessment were motor speed and coordination, reaction time, selective attention, visuospatial ability, verbal and non-verbal short-term and long-term memory, and executive function tests from the neurocognitive test battery EuroCog and the Wechsler Memory Scale III. Results were analyzed with Student’s t-tests and multivariate analyses adjusting for sex, age at time of injury/exposure, and age at assessment were performed with Factorial ANOVAs. Results The exposed and unexposed groups did not differ in any of the neuropsychological measures and results did not change when sex, age at time of injury/exposure, and age at assessment were included in the analyses. Conclusion A head CT examination at the age of 6–16 years does not seem to affect later cognitive functions.

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.

This study investigated the association between self-perceived oral health and self-reported exposure to different types of child abuse. It was hypothesized that self-perceived oral health is compromised in exposed adolescents. All Grade-9 compulsory school and second-year high-school pupils in Södermanland County, Sweden (n = 7,262) were invited to take part in a population-based survey; 5,940 adolescents responded. Survey items on health and social wellbeing included self-perceived oral health and exposure to abuse. The results showed that poor self-perceived oral health was associated with self-reported experience of physical abuse, intimate partner violence, forced sex, and bullying (adjusted OR = 2.3-14.7). The likelihood of reporting poor oral health increased from an adjusted OR of 2.1 for a single incident of abuse to an adjusted OR of 23.3 for multiple abuses. In conclusion, poor self-perceived oral health and previous exposure to child physical abuse, intimate partner violence, bullying, and forced sex is associated. It is important that dental professionals recognize adolescents with poor subjective oral health and take into consideration child abuse as a possible cause in order to prevent these adolescents from further victimization. These results further strengthen that dental professionals are an important resource in child protection.

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.

Diffusion MRI improves detection of abnormalities in white matter tracts in cerebral palsy (CP). Relationships between diffusion measurements and hand function are largely unexplored. We aimed first to assess microstructure of corticofugal fibers, and second to explore associations between tract injury as assessed by quantitative analysis of diffusion MRI and hand function in children with unilateral CP. Methods: In this cross-sectional study, 15 children with unilateral CP (6 boys, median age 12.4 years, min 7.2, max 17) and 24 controls were included (9 boys, median age 12.7 years, min 8.8, max 17.3). Hand function was assessed with the Box and Blocks (B&B) test. Magnetic resonance diffusion data ( b value = 1,000 s/mm 2 , 45 directions) were collected on a 1.5-T scanner. Fractional anisotropy (FA), mean diffusivity (MD), and tensor eigenvalues were measured bilaterally in the cerebral peduncle (ROI1), the posterior limb of the internal capsule (PLIC, ROI2), and corticofugal fibers connecting these regions. Results: In children with CP, FA in both ROIs and the partial tract corresponding to the affected hand was significantly lower compared to controls. This was caused by an increase in diffusivity perpendicular to the tract. After controlling for age, mean FA contralateral to the affected hand correlated with B&B scores, which was independent of lesion type or number of voxels in the partial tract, cerebral peduncle, or PLIC. Conclusions: FA in corticofugal fibers is a sensitive marker of damage to the motor system and correlates with hand function in CP. Using FA may improve early prediction of outcome. Neurology ® 2011;77:775–783

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

Background: For decades, normalized one-dimensional (1D) measures have been used in the evaluation of brain atrophy. In multiple sclerosis (MS), the use of normalized linear measures over longitudinal follow-up remains insufficiently documented. Purpose: To evaluate the association between different regional atrophy measures and disability in MS patients over four decades in a longitudinal cross-sectional study. Material and Methods: 37 consecutively selected MS patients were included. At baseline, patients had a range of disease duration (1–33 years) and age (24–65 years). Each patient was followed by magnetic resonance imaging (MRI) for a mean of 9.25 years (range 7.3–10 years). Four 1D measures were applied at three time points on axial 5-mm T1-weighted images. Three clinical MS subgroups were represented: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS). Results: There were significant changes in all 1D ratios during follow-up. The Evans ratio (ER) and the bifrontal ratio (BFR) were associated with the development of disability. Changes of ER and BFR reflected more aggressive disease progression, as expressed by MS severity score (MSSS). Conclusion: All four normalized ratios showed uniform atrophy progression, suggesting a consistent rate of atrophy over long-term disease duration independent of MS course. Disability status correlated with 1D measures, suggesting that serial evaluation of Evans and bifrontal ratios might contribute to the radiological evaluation of MS patients.

SUMMARY The pathophysiology of pseudotumor cerebri is unclear, but may relate to an abnormality in water transport in the brain. The authors performed MR imaging in seven children with pseudotumor cerebri; the signal intensity in the white matter was normal in all patients. These data suggest that periventricular brain water content is not increased markedly in children with pseudotumor cerebri. The authors speculate that this may relate to the establishment of an equilibrium between increased resistance to cerebrospinal fluid outflow and increased brain stiffness, occurring as a consequence of increased cerebral blood-volume and/or interstitial pressure. RESUME Imagerie par resonance magnetique dans la pseudotumeur cerebrale La physiopathologie de la pseudotumeur cerebrale n'est pas claire mais pourrait etre reliee a une anomalie due au transport hydrique dans le cerveau. Les auteurs ont pratique des IRM chez sept enfants avec pseudotumeur cerebrale; l'intensite du signal dans la substance blanche etait normale chez tous les patients. Les donnees suggerent que ce contenu hydrique cerebral peri-ventriculaire n'est pas accru de facon marquee chez les enfants porteurs de pseudotumeur cerebrale. Les auteurs se demandent si cela ne pourrait s'expliquer par un equilibre entre une resistance accrue a la circulation du liquide cephalo-rachidien et un accroissement de la raideur cerebrale, apparaissant comme une consequence de l'accroissement du volume sanguin cerebral et/ou de la pression interstitielle. ZUSAMMENFASSUNG Magnet-Resonanz-Tomographie beim Peudolumor cerebri Die Pathophysiologic des Pseudotumor cerebri ist unklar, hangt aber vielleicht mit einer Unregelmasigkeit des Wassertransports im Gehirn zusammen. Die Autoren haben bei sieben Kindern mit Pseudotumor cerebri Kernspintomogramme gemacht; bei alien Patienten war die Intensitat in der weisen Substanz normal. Diese Daten lassen vermuten, das der periventrikulare Wassergehalt bei Kindern mit Pseudotumor cerebri nicht stark erhoht ist. Die Autoren sind der Meinung, das dies mit der Herstellung eines Gleichgewichtes zwischen erhohtem Widerstand gegen Liquorausflus und erhohter Hirnverhartung zusammenhangt, was als Folge eines erhohten cerebralen Blutvolumens und/oder Interstitiellen Druckes auftritt. RESUMEN Imagen por Resonancia Magnetica en el pseudotumor cerebral La fisiopatologia del pseudotumor cerebral no esta clara, pero puede relacionarse con una anomalia en el transporte del agua en el cerebro. Los autores practicaron RM en siete ninos con pseudotumor cerebral; en todos los pacientes la densidad de la substantia blanca era normal. Estos hallazgos sugieren que el contenido de agua periventricular no esta muy aumentado en ninos con pseudotumor cerebral. Los autores especulan que puede estar en relacion con el establecimiento de un equilibrio entre un aumento de la resistencia del curso del LCR y un aumento de la rigidez cerebral, como consecuencia de un aumento del volumen de sangre cerebral y/o de la presion intersticial.

SUMMARY Computed tomography (CT) of the brains of 70 children with permanent cortical visual impairment (CVI) and of 25 children who recovered from their cortical visual loss were analysed and the findings were correlated with clinical signs and symptoms. The 70 children with CVI were divided into groups depending on the known or suspected pathophysiology of CVI. Asphyxia caused permanent CVI in 34 children, of whom 16 were preterm, 17 were term and one lost vision later in life. Congenital brain malformations were the second largest group, followed by trauma, infections and shunt failure. 25 children recovered their visual acuities, but six of them were left with homonymous hemianopia. The results identified various clinical characteristics of the groups. CT scanning was helpful in understanding the pathophysiology of CVI, and provided useful information for the prognosis of visual recovery. ReSUMe Scanner cerebral d'enfants avec troubles visuels corticaux Les tomodensitometries (CT) des cerveaux de 70 enfants presentant des troubles visuels corticaux permanents (CVI) et de 25 enfants ayant recupere leur perte visuelle corticale ont ete etudiees et les donnees correlees avec les signes cliniques et les symptomes. Les 70 enfants avec CVI ont ete diffuses en deux groupes en fonction d'une physiopathologie de CVI connue ou suspectee. L'asphyxie provoquait des CVI permanents chez 34 enfants dont 16 prematures, 17 nes a terme et un ayant perdu la vision plus tardivement au cours de la vie. Les manifestations congenitales cerebrales constituaient le second groupe le plus etendu suivi par le traumatisme, l'infection et l'echec de valve. 25 enfants recuperent leur acuite visuelle mais une hemianopsie homonyme persista chez six d'entre eux. Les resultats permettent d'isoler des caracteristiques cliniques des groupes varies. Le scanner CT fut utile dans la comprehension de la physiopathologie des CVI et fournit des renseignements utiles pour le pronostic de la recuperation visuelle. ZUSAMMENFASSUNG Komputertomographie des Gehirns bei Kindern mit kortikaler Sehstorung Die Komputertomogramme (CT) des Gehirns von 70 Kindern mit permanenter kortikaler Sehstorung (CVI) und 25 Kindern, die einen kortikalen Sehverlust hatten, wurden analysiert und die Ergebnisse wurden mit klinischen Befunden und Symptomen korreliert. Die 70 Kinder mit CVI wurden entsprechend der bekannten oder vermuteten Pathophysiologie der CVI in Gruppen eingeteilt. Bei 34 Kindern wurde die CVI durch Asphyxie verursacht, davon waren 16 Fruhgeborene, 17 am Termin geboren und eins verlor das Sehvermogen erst spater. Die zweitgroβte Gruppe bildeten die kongenitalen Hirnmiβbildungen, gefolgt von Traumen, Infektionen und Ventilkomplikationen. 25 Kinder erlangten ihre Sehkraft wieder, aber sechs behielten eine homonyme Hemianopsie. Die Untersuchungsergebnisse deckten verschiedene klinische Charakteristika bei den Gruppen auf. Die CT-Untersuchungen waren fur das Verstandnis der Pathophysiologie von Bedeutung und erbrachten verwertbare Informationen fur die Prognose der Wiedererlangung des Sehvermogens. RESUMEN TAC cerebral en nihos con alteraciones del cortex cerebral La TAC cerebral de 70 ninos con alteracion visual cortical permanente (ACV) y de 25 ninos que se recuperaron de su perdida cortical visual, fueron analizadas y los hallazgos se correlacionaron con signos y sintomas clinicos. Los nifios con ACV fueron divididos en grupos segun la fisiopatologia conocida o sospechada de su ACV. La asfixia era la causa de ACV permanente en 34 ninos, de los cuales 16 eran pretermino, 17 eran a termino y uno con perdida de la vision mas tardia. El segundo grupo mas grande fueron las malformaciones cerebrales, seguidas de trauma infecciones y fallo en derivaciones. 25 ninos recuperaron sus agudezas visuales pero a diez les quedo una hemianopsia homonima. Los resultados identificaron varias caracteristicas clinicas de los grupos. La TAC fue util para entender la fisiopatologia de la ACV y proporciono una informacion util para el pronostico de la recuperacion visual.

Aim: To investigate associated neurological, endocrinological and cognitive dysfunctions in children with visual impairment caused by optic nerve hypoplasia or optic nerve/fundus coloboma and/or microphthalmus. Methods: Forty children born between 1990 and 1998 were assessed by neurological examination, re-evaluation of neuroradiological investigations, review of medical records and examination of cognitive levels. Results: Neurological dysfunctions (epilepsy and/or motor impairment) were found in 13/28 children with optic nerve hypoplasia and in 3/12 children with coloboma/microphthalmus. The optic pathways were thin in 22/24, an abnormal posterior pituitary gland and/or thin infundibulum was found in 16/22 and absence of septum pellucidum in 14/27 children with optic nerve hypoplasia. Other types of cerebral abnormalities occurred in 9/26 children. Among children with coloboma/microphthalmus, the optic pathways were thin in 4/8 children but none had pituitary or cerebral midline abnormalities. Sixteen children with optic nerve hypoplasia were receiving hormone substitution but none of the children with coloboma/microphthalmus. Thirteen of the 16 children with optic nerve hypoplasia and with an abnormal pituitary region had endocrinological deficiencies. Mental retardation was found in 9/24 of the children with optic nerve hypoplasia and in 5/10 of the children with coloboma/microphthalmus. Conclusion: Endocrinological, neurological and neuroradiological defects seem more common in children with optic nerve hypoplasia than in children with coloboma. A pituitary region that appears abnormal in magnetic resonance imaging seems to predict endocrinological deficits in children with optic nerve hypoplasia.

AIM There is limited literature on brain imaging studies of children with cerebral palsy (CP) in low and middle income countries. We investigated neuroimaging patterns of children with CP attending a tertiary referral centre in Uganda to determine how they differed from studies reported from high income countries and their relationship with prenatal and postnatal factors. METHODS Precontrast and postcontrast computed tomography (CT) scans of 78 CP children aged 2-12 years were conducted using a Philips MX 16-slice CT scanner. Two radiologists, blinded to the patient's clinical status, independently reviewed the scans. RESULTS Abnormal CT scans were detected in 69% of the children sampled, with very few having primary white matter injuries (4%). Primary grey matter injuries (PGMI) (44%) and normal scans (31%) were most frequent. Children with a history of hospital admission following birth were three times more likely to have PGMI (odds ratio [OR] 2.8; 95% CI 1.1-7.1), suggesting a perinatal period with medical complications. CONCLUSION Brain imaging patterns in this group of CP children differed markedly from imaging studies reported from high income countries, suggesting a perinatal aetiology in full-term infants and reduced survival in preterm infants.

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.

The importance of UEMS is well known to many medical specialists in Europe. UEMS (Union Europeenne des Medecins Specialistes/European Union of Medical Specialists) today represents 35 national organisations, some 1.6M medical specialists, and is involved in professional issues important to European specialists. UEMS, as an officially recognised and permanent consulting organisation to the European Institutions, has a significant influence on how these issues are formulated in Directives and Laws introduced in the European Parliament. UEMS is the one and only representation of medical specialists for the European Commission and Parliament. Most decisions regarding medical specialists are prepared in cooperation with UEMS. The full members of UEMS are the National Medical Associations; each specialty is represented by a Section or a Division. To have a UEMS Section or Division means that your specialty is recognised in Europe. The Division of Neuroradiology is the face and voice of European Neuroradiology in Brussels and thus in Europe. The Division truly represents all European neuroradiologists as a "Union" and is representing neuroradiologists in professional and legal issues. Scientific issues, however, are managed by the Scientific societies, while educational and training are shared interests.

Four children with visual impairment caused by periventricular leukomalacia were followed with regard to their development of visual and cognitive functions, visual-spatial ability, and behavior. The process of learning to read was monitored. The cognitive profiles were uneven, with higher scores on verbal than on visual-spatial subtests. The latter were far below average. Eye movements while reading were recorded. We found some improvement of visual acuity and visual fields with time. After a two-year follow-up, three children were able to read print, although one of them preferred Braille. One child, who had spastic diplegia, could not read print or Braille, but could type on a keyboard with the help of synthesized speech. The children had difficulties making eye movements during reading; they compensated with head movements.

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.

International audience; This paper reports work in progress on X-ray angiography acquired under stereotactic conditions. The objective is to be able to match multimodality images (typically MRI and X-ray) without a stereotactic frame but with stereotactic precision. We have identified potential problems and have studied them in detail. We conclude that, although the overall application is feasible, much work remains to be done on the estimation of the X-ray system conic projection and on automatic matching based on vascular structures.

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 …

A case of congenital myotonic dystrophy is reported which was complicated by the development of a hydrocephalus that needed ventricular-peritoneal shunting at the age of 4 months. Although dilatation of cerebral ventricles is a common feature in these patients, an occlusive hydrocephalus has not so far been reported.

To relate visual field function to brain morphology in children with unilateral cerebral palsy (CP).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.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.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.

AIM: The aim is to evaluate medical record documentation regarding potential abusive head injury (AHI) in infants presenting to a Paediatric Emergency Department (ED) with certain primary complaints known to be associated with AHI. METHODS: A database search was performed to find all medical records over a period of one year relating to those children who had one AHI-related primary complaint and who had had a CT head-scan performed in conjunction with admission. Each medical record was reviewed, in order to assess whether potential abuse had been investigated and documented. Each CT-scan image was re-evaluated for missed indications of potential injuries attributable to AHI. RESULTS: Forty-seven such medical records were found. Of these, 87% showed the diagnosis to be head injuries. The largest group of children was in the age group 0-3 months (38%). Of the children admitted to the Paediatric ED due to a head injury, 54% had a history deemed to raise suspicions of abuse but only five of them had had a documented investigation of child abuse. The re-evaluation of the CT-scans showed no missed cases. CONCLUSION: In this study we found that among children with known risk factors for AHI, only a few had documentation regarding potential child abuse. The use of a standardized protocol could be helpful in the important work to help staff discover potential AHI. Language: en

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

CT brain scans were used to evaluate the most likely etiology of hemiplegic cerebral palsy in a group of children born at term. The population based study group comprised 83 children. The CT findings were classified to reflect the phase of brain maturation during which the injury causing hemiplegia most likely had occurred. The most common finding (37%) was periventricular atrophy considered to represent periventricular leukomalacia (PVL). PVL is a form of hypoxic-ischemic damage typical of the immature brain and most commonly seen as a complication of preterm birth. As this lesion was found in children born at term it was considered to reflect a cerebral injury that had occurred in utero. Cerebral maldevelopment, due to a very early intrauterine lesion, was detected in 17%, while cortical-/subcortical lesions, previously considered to be of major importance in hemiplegia, were seen in just 16% of the children. Altogether the CT findings indicated a prenatal origin of hemiplegia in 57%. Assessing the time of injury based on clinical records concurred with prenatal origin in 32% of the children thought to have prenatal origin of hemiplegia by CT. The objective information available from careful review of imaging information such as CT brain scans, is an important adjunct to clinical data. We propose that assessment of brain morphology, by means of imaging, should be integrated with clinical assessment when evaluating the etiology of brain lesions in children with congenital motor impairment.

4 patients with acquired arteriovenous shunts located in the wall of an ectatic vein of Galen (VG) are reported. They represent so-called VG dural arterio-venous malformations (DAVM). These shunts involve the vasa vasorum normally present in the VG wall. Physiopathology, clinical signs and age groups are usually the same as those encountered in other DAVMs; conversely they are totally different from the other mural shunts of the VG, detected in the pediatric population (true VG arteriovenous malformations), and leading to different clinical symptoms. Venous approach in these VG DAVMs is almost always contraindicated unless secondary occlusion of VG afferent has spontaneously excluded the pouch from the cerebral venous circulation.

Background: In multiple sclerosis (MS), brain atrophy assessed by linear measurements of ventricular widths has been reported to be well correlated with three-dimensional (3D) measurements. Therefore, serial linear measurements with no need for advanced 3D evaluation may be proven to be robust markers of irreversible, destructive changes. Purpose: To evaluate the rate of supratentorial ventricular enlargement representing four decades of disease span. Material and Methods: 37 MS patients with disease duration at baseline ranging from 1 to 33 years were included. The mean time of the individual magnetic resonance imaging (MRI) follow-up was 9.25 years (range 7.3–10 years). Enlargement rate of the third and lateral ventricles was studied over time by applying three linear measurements on axial 5-mm T1-weighted MRI images. Results: Progression of supratentorial ventricular widths during 9 years’ follow-up was found. The mean annual width increase of the third ventricle was 0.20 mm ( P Conclusion: We found uniform ventricular enlargement progression during four decades of disease span, suggesting unchanging total brain atrophy progression over time.

Intraventricular hemorrhage is an uncommon problem in the full-term newborn. In a review of 19 full-term infants with intraventricular hemorrhage diagnosed on computed tomography prior to 1 month of age, thalamic hemorrhage associated with the intraventricular hemorrhage was documented in 12 infants. Thus, thalamic hemorrhage appears to be the most common source of intraventricular hemorrhage in this age group, particularly in infants who had uneventful birth histories and in whom clinical abnormalities (signs of increased intracranial pressure, seizures, altered level of consciousness) developed after the first week of life. The majority of these infants had predisposing factors for cerebral venous infarction such as sepsis, cyanotic congenital heart disease, and coagulopathy. The clinical appearance and outcome for infants with thalamic hemorrhage/intraventricular ular hemorrhage were similar to those in infants with intraventricular hemorrhage originating from other sites, except for an increased incidence of cerebral palsy in infants with thalamic hemorrhage/intraventricular hemorrhage. Definitive diagnosis was made on the basis of characteristic radiologic abnormalities.

We report on two brothers with renal hypophosphatemia, intracerebral calcifications, minor facial anomalies, and short distal phalanges. The children presented with recurrent dental abscesses; one had premature closure of the anterior fontanelle. Biochemical findings included hypophosphatemia and elevated serum alkaline phosphatase with normocalcemia. Blood levels of parathyroid hormone, 1,25(OH)2 and 25(OH) vitamin D levels were normal; TRP (the fractional tubular reabsorption of PO4) and TmP/GFR (the tubular maximum rate of PO4 reabsorption in relation to GFR) were low. Both parents had a normal serum phosphate and brain CT scan without evidence of calcifications. This apparently new syndrome of renal hypophosphatemia associated with intracerebral calcifications appears to be inherited as either an autosomal recessive or an X-linked trait.

As part of a multidisciplinary study, the rate of autism spectrum disorder (ASD), learning disability (LD), and brain abnormalities was examined in 20 participants (12 males, 8 females; age range 8mo-17y, mean age 8y 1mo) diagnosed as falling within the oculoauriculovertebral spectrum (OAV). A neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Two individuals met diagnostic criteria for autism, one for autistic-like condition, and five for autistic traits. Four patients had mild LD, three severe LD, two profound LD, and two borderline intellectual functioning. Neuroimaging indicated cerebral abnormalities in more than half of the patients. Abnormalities of white/grey matter were found in more than half of examined individuals; enlargement of ventricles in more than a third. Results indicate that at least a subgroup of ASD may be associated with errors in early embryonic brain development. Awareness of the coexistence of OAV/ASD is important in habilitation care of individuals with OAV.