HEMINEGLECT AND SEIZURES IN BINSWANGER-DISEASE - CLINICAL-PATHOLOGICAL REPORT

The range of clinical effects from ischaemic damage to white matter in Binswanger's disease has not been fully characterised. Although focal deficits and seizures occur frequently, superficial infarcts often co exist, making the cause of these symptoms unclear. The case of a 69 ye ar old woman is described who presented with acute left sided weakness and hemispatial neglect, followed a year later by electrographically documented seizures originating from the right hemisphere. Interim exa minations showed bilateral pyramidal signs and mild intellectual decli ne. Serial CT and MRI studies showed bilateral diffuse ischaemic lesio ns of the cerebral white matter and old left sided lacunar infarcts bu t no evidence of acute infarction. Post- mortem examination showed gli osis and demyelination of the deep white matter which spared the subco rtical arcuate fibres; this is consistent with Binswanger's disease. T he neocortex was normal. This case and previous reports indicate that focal symptoms typically referable to the grey matter, including hemin eglect and seizures, may occur as a manifestation of subcortical ischa emic injury to white matter in Binswanger's disease.