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We studied 33 consecutive patients with computed tomographic findings of decreased density in the periventricular white matter (leukoaraiosis). Computed tomograms in five (aged 56-75 years) of the 33 demonstrated intracerebral hematoma. The hemorrhages were situated in the thalamic area in four and in the parietotemporal area in one patient. These five patients were hypertensive and had signs characteristic of parenchymal hemorrhage. Three of the five patients had progressive dementia prior to the ictus, and two of the three also had a history of single or multiple strokes. There was no significant difference in the clinical findings of hematoma patients with or without leukoaraiosis. {Stroke 1989;20:1016-1020) I mproved contrast resolution of currently available computed tomographic (CT) scanners has resulted in the frequent demonstration of white matter lucencies in the brains of elderly patients. Bilateral and symmetric periventricular white matter lucencies, or leukoaraiosis, 1 found on CT scans has been attributed to several diseases (such as multiinfarct dementia or Binswanger's disease or dementia of the Alzheimer type) and to normal aging. We describe five patients who had leukoaraiosis and intracerebral hematoma on their CT scans, and we discuss the possible mechanisms of periventricular white matter lucencies and intracerebral hematoma. Subjects and MethodsFrom February to July 1988, 2,275 patients underwent technically satisfactory brain imaging at the CT unit of Hacettepe University Medical School during routine clinical operation. The CT scans were done using a third-generation scanner (Philips Tomoscan 350, Eindhoven, The Netherlands). A diagnosis of leukoaraiosis based on cranial CT examinations of adults was made when two investigators independently found that the white matter of the cerebral hemispheres, including not only the periventricular white matter but also the core of the centrum semiovale, was hypodense. An area was From the Departments of Neurology (K.S.) and Radiology (C.E.), Hacettepe University Medical School, Ankara, Turkey.Address for correspondence: Dr. Kaynak Selekler, Department of Neurology, Hacettepe University Medical School, 06100 Ankara, Turkey.Received January 6, 1989; accepted March 23, 1989. considered lucent if the density was between that of normal white matter and the cerebrospinal fluid. The extent of the periventricular lucencies was graded as mild or marked based on visual impression. The CT scans were also analyzed for ventricular and sulcal enlargement, for cortical atrophy in the frontal, temporal, parietal, and occipital regions, and for central atrophy in the frontal and occipital regions. The presence and location of infarcts and hematomas were also evaluated. Each patient with leukoaraiosis received a neurologic and a complete physical examination, and a neurologic history was taken. Patients were considered hypertensive if their sustained blood pressure was > 140/90 mm Hg or if they were receiving antihypertensive medications because that diagnosis had ...

Twelve cases with circling seizures are presented with their clinical, electroencephalographic and radiological findings. Four patients had symptomatic partial epilepsy, five had cryptogenic partial epilepsy, and the remaining three had idiopathic generalized epilepsy. Three of the patients with symptomatic partial epilepsy had frontal lesion, and one had parito-occipital lesion. Turning direction had no lateralizing value in patients with partial epilepsy. Based on our study we conclude that circling seizures may occur in different epileptic syndromes and epilepsies. In cases with symptomatic partial epilepsy, lesions are mostly located in frontal lobes but also in parietooccipital areas.

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Balo's concentric sclerosis was diagnosed antemortem in 2 patients, by magnetic resonance (MR) imaging showing striking concentric alternating rings in 1 patient and by characteristic histopathological features in the other. The course of the lesions and the concentric pattern were followed by MR imaging for 3 years and 18 months, respectively. One patient demonstrated spontaneous remission that has not been reported in Balo's disease. Balo's disease may not have a fulminant course as described in the past and the MR appearance of the chronic lesion may resemble that of a chronic multiple sclerosis plaque.