We studied MRI findings of a periventricular high-signal intensity pattern in 151 adults older than 50 years. Only 7.8% of patients who had no identified cerebrovascular risk factors and who reported no cerebrovascular symptoms had these MRI periventricular lesions; 78.5% of patients with a history of cerebrovascular risk factors and who had had cerebrovascular symptoms had periventricular patterns.
Computed tomography (CT) was abnormal in 75% of 33 patients with pure motor hemiparesis (PMH). In 13 cases, lesions were detected in the capsular region; 10 were consistent with infarction, and 3 were of increased density consistent with hemorrhage. Seven had other vascular disorders, and four had nonvascular conditions. Of 20 patients with PMH with normal electroencephalogram (EEG), isotope scan, and cerebrospinal fluid, 11 had CT evidence of a lesion in the internal capsule-corona radiata region. In patients with PMH with normal CT, recovery was more complete and rapid than in those with CT evidence of a vascular lesion. In 5 cases, CT showed a capsular lesion, although the patients had never had any neurologic deficit.
Seizures occurred in 15% of patients with parenchymal brain hemorrhage (early in 12% and delayed in 3%). Seizures were most frequent with lobar hemorrhages and uncommon with deep subcortical hemorrhages. Lobar hemorrhages in the frontal, parietal, or temporal region were more commonly associated with seizures, whereas occipital hemorrhages were not. Seizures were most common if the hemorrhage was due to an aneurysm, angioma, or neoplasm and less common if hypertensive or spontaneous. If the patient had recurrent seizures or developed delayed seizures, CT showed that the hemorrhage evolved to a hypodense appearance; if the seizure did not recur, CT showed that the hemorrhage evolved to an isodense appearance.
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