The subcortical arteriosclerotic encephalopathy of Binswanger is characterized clinically by hypertension, dementia, spasticity, syncope, and seizures. It is usually diagnosed pathologically by the finding in white matter of diffuse demyelination or foci of necrosis plus arteriosclerotic and hypertensive vasculopathy. We present a case in which the diagnosis was made on the basis of the clinical course and a computerized tomogram which demonstrated extensive white matter degeneration. Postmortem examination confirmed both the diagnosis and the extent of the degeneration as shown by CT scan.

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S U M M A R Y Forty-nine children with complicated bacterial meningitis were studied. Thirteen had abnormalities on computed tomography compatible with the diagnosis of brain infarction; one had a brain biopsy with the histological appearance of infarction. Factors exist in childhood bacterial meningitis which are associated with the development of brain infarction.Although antibiotics have been successful in eradicating the infecting organtism in many cases of childhood bacterial meningitis, major neurological complications continue to occur.'-3 For many decades physicians have relied upon necropsy to determine the pathogenesis of 'these complications.46 Only limited help has been obtained from cerebral arteriography and pneumoencephalography.78 The complexity and risk of such procedures prevent wide use.9'10 Recent application of computed tomography of the brain (CT) has provided a unique and relatively simple noninvasive radiographic method for examining those children with bacterial meningitis who developed neurological complications. 11-14 CT has provided additional information concerning the pathogenesis of the neurologic complications.

Sixty-six patients with acute ruptures of the Achilles tendon were treated by immobilisation in a plaster cast for 12 weeks. Fifty-seven were followed up for a mean time of 70 months. Four re-ruptures occurred shortly after the initial treatment. Most patients had no or only slight complaints, three had moderate and one severe, problems. The activity level dropped slightly from 5.3 to 5.03 (Tegner score). The results are satisfactory with a low complication rate. The method is an alternative to operative repair, especially in patients declining operation and in those in whom operation or anaesthesia is contraindicated.

Pathophysiological and CT aspects of wallerian degeneration of the corticospinal tract in the brain stem were studied in patients with old hemispheric infarcts. There was found to be a clear relationship between (a) the location and size of the infarcts and (b) the presence or absence of wallerian degeneration. When most of the motor cortex is involved, degeneration can be seen at least as far as the mesencephalic level and sometimes down to the pontine level. Isolated capsular infarcts which spare the motor cortex are also associated with degeneration. No degeneration could be seen in patients with small infarcts.