Magnetic resonance imaging (MRI) has revealed age-related changes in midbrain volume in normal subjects. Atrophy of the midbrain in patients with progressive supranuclear palsy (PSP) has been demonstrated using conventional brain MRI, and it was recently reported that some patients with vascular dementia also have midbrain atrophy. The aim of the present study was to investigate if the patients with subcortical ischemic vascular dementia (SIVD) have atrophic changes in the midbrain. MRIs of 23 SIVD patients, 18 probable PSP patients, and 96 controls were retrospectively analyzed. Differences in the distances between midbrain structures were compared across the patient groups and controls. We measured the anteroposterior diameter (AP), and the distance between the interpeduncular fossa and the aqueduct (IF–AQ), the aqueduct and posterior margin of the superior colliculi (AQ–SC), and the peduncular prominence and the interpeduncular fossa (PP–IF) of the midbrain. The AP diameter and IF–AQ were negatively correlated with age in normal controls (r = -0.21, p < 0.005 for AP; r = -0.14, p < 0.0001 for IF–AQ). In SIVD patients, the AP diameter and IF–AQ were both significantly smaller than in controls (p < 0.001). Changes in the midbrain found for SIVD patients were similar to those seen in PSP patients. Our results suggest that the midbrain decreases in size with normal aging, especially around the tegmental region. This change is more pronounced in patients with SIVD and in patients with PSP. Prospective functional studies are needed to ascertain the clinical relevance of midbrain atrophy in SIVD.

Midbrain atrophy in subcortical ischemic vascular dementia.

Management and Care – The Changing Landscape of Multiple Sclerosis In early June 2008, the 18th meeting of the European Neurological Society (ENS) welcomed over 3,000 neurologists and physicians from all over the world to Nice, France. Among the multitude of symposia, oral sessions and scientific programmes on the latest in the progress made in neurodegenerative diseases were presentations by leaders in the field of multiple sclerosis (MS). Noted key points discussed included new developments in research, and the concept that drug efficacy varies depending on the treatment stage: beginning treatment earlier in the course of the disease may be more beneficial. With strong evidence presented in support of initiating treatment earlier, neurologists have been offered the opportunity to protect patients against disease progression. By implementing early intervention it may be possible to improve the prognosis of this debilitating neurodegenerative disease.

Management and Care – The Changing Landscape of Multiple Sclerosis

Morphology of the adult midsagittal brainstem in relation to the reference systems MRI-based variability study.

Prevention of conversion of clinically isolated syndromes to clinically defined multiple sclerosis. Evidence from a Cochrane meta-analysis

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Prevention of conversion of clinically isolated syndromes to clinically defined multiple sclerosis. Evidence from a Cochrane meta-analysis