Tremor in people with multiple sclerosis (MS) is a frequent and debilitating symptom with a relatively poorly understood pathophysiology. To determine the relationship between clinical tremor severity and structural magnetic resonance imaging parameters. Eleven patients with clinically definite MS and right-sided upper limb tremor were studied. Tremor severity was assessed using the Bain score (overall severity, writing, and Archimedes spiral drawing). Cerebellar dysfunction was assessed using the Scale for the Assessment and Rating of Ataxia. Dystonia was assessed using the Global Dystonia Scale adapted for upper limb. For all subjects, volume was calculated for the thalamus from T1-weighted volumetric scans using Freesurfer. Superior cerebellar peduncle (SCP) cross-sectional areas were measured manually. The presence of lesions was visually determined and the lesion volumes were calculated by the lesion growth algorithm as implemented in the Lesion Segmentation Toolbox. Right thalamic volume negatively correlated with Bain tremor severity score (ρ = − 0.65, p = 0.03). Left thalamic volume negatively correlated with general Bain tremor severity score (ρ = − 0.65, p = 0.03) and the Bain writing score (ρ = − 0.65, p = 0.03). Right SCP area negatively correlated with Bain writing score (ρ = − 0.69, p = 0.02). Finally, Bain Archimedes score was significantly higher in patients with lesions in the contralateral thalamus. Whole brain lesion load showed no relationship with tremor severity. These results implicate degeneration of key structures within the cerebello-thalamic pathway as pathological substrates for tremor in MS patients.

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environmental factors and the effect on infant growth and development at the postpartum 8th month. Method As a part of the cohort study at Hacettepe University Department of Social Paediatrics, 74 breast milk samples and 46 infant hair samples were taken at the postpartum 8th month. Mothers' environmental exposure were evaluated by a semistructured questionnaire. Results Pb, Hg, Cd were detected in breast milk samples of 91%, 87%, 99%, respectively. Breast milk Hg levels were associated with maternal vitamin use within the first 2 months after delivery, breast milk Cd levels were higher in cases with expanded family, living in older house and in urban with air pollution during childhood. Higher infantile hair Cd levels were higher in cases with expanded family, living older house, maternal history of anaemia and postpartum anaemia. In girls z scores of birth weight, height for age at the 8 th month were inversely correlated with infant hair Pb levels. In boys, z scores of body mass index at the 8th month were inversely correlated with infant hair Cd levels. The levels of breast milk Hg levels were higher in infants with Denver II suspicious/abnormal. Conclusion It is suggested that presence of Pb, Hg, Cd in breast milk and infant hair have been affected infants of developmental and growth parameters. Preventive measures must be taken to reduce environmental toxic metals pollution and efforts should be made for the management of anaemia in females in all age groups. Background The authors report a case of Hypomelanosis of Ito (HI), a rare neurocutaneous syndrome associated with musculoskeletal, neurological alteration and ophthalmologic abnormalities. Methods A 9 month old girl was brought for evaluation of hypopigmented skin lesions and strabismus. Clinical examination revealed whirled hypochromic skin lesions only in the left side of the body (neck and trunk) following the lines of Blaschko, compatible with HI and hypotonia. She presents also: strabismus, genu valgus and pubis pilosity. She attained head control at 4 month and failure to sit without support. Results The blood tests, hormonal tests, abdominal and cranial ultrasound were normal. Electroencephalogram revealed diffuse cortico-subcortical dysfunction. MRI of head was normal. Blood karyotyping showed mosaicism. Differential diagnosis: nevus depigmentosus, tuberous sclerosis, vitiligo. Treatment: no treatment for the cutaneous lesions. Appropriate specialty care for orthopaedic and visual problems. Conclusions 1. Numerous complications have been associated with HI involving the central nervous system, musculoskeletal, ophthalmologic alteration and urogenital malformation. PO-0374 HYPOMELANOSIS OF ITO -CASE REPORT

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