Cerebrovascular disease in Saudi Arabia

Clinical characteristics, Risk factors, and outcomes of Posterior circulation stroke: A retrospective study between younger and older adults in Saudi Arabia

INTRODUCTION

Posterior circulation stroke (PCS) may be less prevalent than its anterior counterpart but contributes to substantial morbidity and mortality. The aim was to characterize PCS's demographics, clinical presentation, management, and outcomes between younger and older adults in Saudi Arabia.

METHODS

This retrospective cohort study was conducted at two tertiary medical centers in Saudi Arabia between March 2016 and December 2020. All patients who presented with symptoms of posterior circulation stroke and had positive brain imaging were included.

RESULTS

The study involved 160 posterior circulation stroke patients, stratified into two age groups: 71 patients aged 18-59 years and 89 patients aged 60 years and above. The mean age of the entire cohort was 60.9 years, and 77 % were males. Hypertension was more prevalent in the older age group (88 % vs. 69 %, p=0.005), and smoking was significantly higher among younger patients (38 % vs. 15 %; p=0.0009). Only 22.4 % received thrombolysis and/or thrombectomy. Most strokes involved the posterior cerebral artery (45.6 %). Large artery atherosclerosis was the most common subtype. At discharge, younger patients had higher NIHSS compared to older patients.

CONCLUSION

Our investigation of 160 PCS patients in Saudi Arabia uncovers notable trends: a mere 22.4 % received thrombolysis and/or thrombectomy and a significant prevalence of posterior cerebral artery involvement due to large artery atherosclerosis. The study further reveals younger patients disproportionately had severe outcomes. Highlighting the need for improved stroke care and heightened awareness, this research contributes vital data to an underexplored domain, urging further study to optimize care and understand PCS dynamics in Saudi Arabia.

Cerebrovascular Risk Profiles in a Saudi Arabian Cohort of Young Stroke Patients

Background: The constantly increasing incidence of stroke in younger individuals substantiates an urgent need for research to elucidate underlying risk factors and etiologies. Heretofore, the vast majority of studies on stroke in the young have been carried out in European and North American regions. We aimed to characterize cerebrovascular risk profiles in a Saudi Arabic cohort of consecutive young stroke patients.

Methods: We retrospectively analyzed data from consecutive ischemic stroke patients aged 15 to 49 years who underwent detailed cardiocerebrovascular evaluation at a tertiary stroke care center in Makkah, Saudi Arabia. Distributions of risk factors and stroke etiologies were assessed in the entire cohort and in two strata of very young (15–40 years) and young to middle-aged patients (41–49) to account for variability in suggested age cutoffs.

Results: In the entire cohort [n = 63, ages 44 (34–47) median, interquartile range], dyslipidemia (71.4%) and small vessel occlusion (31.7%) displayed highest prevalence followed by diabetes (52.4%) and cardioembolism (19%). In very young patients, cardioembolism was the most prevalent etiology (27.3%). Risk profiles were similar between both age strata except for a higher prevalence of diabetes among the older cohort (31.8 vs. 63.4%, p = 0.01). Logistic regression identified diabetes as strongest predictor for association to the older strata (odds ratio = 4.2, 95% confidence interval = 1.2–14.1, p = 0.02).

Conclusion: Cerebrovascular risk profiles and stroke etiologies in our cohort of young stroke patients differ from those of previous cohorts, suggesting the need for tailored prevention strategies that take into account local epidemiological data on cerebrovascular health.

Clinical presentations, radiological characteristics, and biological risk factors of cerebral venous thrombosis at a University Hospital in Saudi Arabia

OBJECTIVES

To describe the clinical features and possible etiologies of cerebral vein thrombosis (CVT) in a Saudi Arabian cohort.

METHODS

A retrospective, observational design was implemented. Data pertaining to 36 patients (19 female and 17 male) with confirmed CVT diagnosis admitted to a hospital in Saudi Arabia between 2008 and 2019 were obtained and analyzed.

RESULTS

The age of patients ranged between 19 to 82 years, and the mean/median age was 33/29 years. Most commonly reported symptoms were headache ( 72%), unilateral lower limb weakness (39%), and seizures (17%). Papilledema was found in 8% of patients. Thrombotic disorders were identified in 14% and infections were identified in 8% of the patients. Two patients had ulcerative colitis, 2 were diagnosed with Behcet's disease, and 2 women were using oral contraceptive pills. Single sinus thrombosis was detected in only 22% of patients. One patient with diabetic ketoacidosis died. Thrombotic disorder was the most common risk factor, followed by that iron deficiency anemia.

CONCLUSION

The transverse sinus was the most frequently thrombosed sinus. Iron deficiency anemia emerged as a predisposing preventable condition for CVT, while genetic factors were found to be less important in this cohort.

Burden of stroke in the Kingdom of Saudi Arabia: A soaring epidemic

Stroke is a key cerebrovascular disease that is related to high morbidity and mortality in the globe. The Kingdom of Saudi Arabia (KSA) is not an exception where stroke is fast developing into a serious challenge due to the high mortality rate. Additionally, stroke presents a tremendous economic burden and has a devastating effect on the quality of lives of individuals. The number of stroke cases are increasing yearly, thus posing a major challenge to the health care system. Therefore, it is crucial to implement primary and secondary prevention strategies in the KSA. Nevertheless, as compared with developed countries, information on the prevalence, socio-demographic properties and prevention of stroke remains scarce that could be attributed to the shortage of research conducted in this specified region. The review is written to address the various aspects of stroke in the KSA, based on current literatures search using PubMed, Scopus, Web of Science and Google Scholar databases, to identify studies published since inception to Dec 2020.

Endoscopic interlaminar lumbar discectomy: How to decrease the learning curve

Background:

Herniated lumbar disc is a common cause of lumbosacral pain. Endoscopic interlaminar lumbar discectomy (ILD) is a well-established technique that provided comparable results to micro-discectomy. The aim of the study is to describe the learning curve of endoscopic ILD and explore measures that could improve effectiveness and decrease blood loss and operative time with accumulation of reasonable experience.

Methods:

This retrospective cohort study included 65 patients presenting with symptomatic herniated lumbar disc who underwent endoscopic ILD. Patients were divided into two groups: Group I (standard technique) and Group II (modified technique). Collected data included patients’ age, gender, preoperative manifestations, visual analog score (VAS) for pain, Oswestry Disability Index (ODI), disc level, operative time, intraoperative blood loss, complications, and follow-up data at 1, 6, and 12 months postoperatively. Primary outcomes included total operative time, amount of intraoperative blood loss, and post-operative improvement in pain. Secondary outcomes included intraoperative complications, rate of conversion to open surgery, and recurrence.

Results:

Post-operative VAS and ODI improved significantly in both groups. Mean total surgical time and intraoperative blood loss were significantly lower in Group II compared to Group I (P < 0.001). The learning curves for operative time and intraoperative blood loss were shallow in Group I, and almost flattened in Group II. Complications were recorded in only three cases, and no symptomatic recurrences were reported.

Conclusion:

The learning curve of endoscopic ILD was shallow with standard technique, indicating difficulties in mastering the procedure. The proposed modified technique helped reaching the required level of proficiency in the early phase of the curve, providing a significant reduction in operative time and blood loss, with comparable effectiveness and safety as the standard technique.

Frequency, risk factors, and outcomes in patients with significant carotid artery disease admitted to King Abdulaziz Medical City, Riyadh with Ischemic Stroke

OBJECTIVE

To determine the frequency, risk factors, and outcomes of significant carotid artery disease (CAD) in patients with ischemic stroke.

METHODS

The frequency of significant CAD in patients admitted to the Stroke Unit between January 2014 and December 2015 was determined from radiological data. Outcomes were determined clinically and radiologically.

RESULTS

Among 435 patients, 273 were men (62.8%), with a mean age of 57.4+/-12.2 years. Significant CAD was found in 48 vessels in 40 (9.2%) patients, of which 30 patients were symptomatic. Nine of these patients were treated with carotid artery stenting, one underwent carotid endarterectomy, and 3 underwent an urgent thrombectomy, without stenting. Seventeen symptomatic patients were not treated for the following reasons: patient/family refusal (n=2), contraindications (n=5), and complete occlusion (n=10). One (7.7%) of the 13 treated patients had an ipsilateral stroke on follow up, one (7.7%) had contralateral transient ischemic attack (TIA), 9 (69.2%) had no recurrence, and no clinical data were available for 2 patients. Among the 17 untreated patients, one (5.9%) had an ipsilateral stroke, 7 (41.2%) had no recurrence, and 9 (52.9%) were lost to follow up.

CONCLUSION

Significant carotid artery disease is uncommon in our cohort found in less than 10% of patients. Vascular risk factors are more or less similar between patients with or without CAD except obesity which appears to have inverse relation with CAD. A small number of patients received carotid intervention with no recurrence of stroke at limited follow up.

Risk factors and subtypes of acute ischemic stroke. A study at King Fahd Hospital of the University

Objective:

To identify the different subtypes of acute ischemic stroke, and estimate the frequency of various risk factors among these patients.

Methods:

In this retrospective, cross-sectional study, we reviewed the medical records of patients admitted with the diagnosis of acute ischemic stroke at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia from March 2008 till December 2015. The demographic characteristics, subtypes of stroke, risk factors (hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, atrial fibrillation, valvular heart disease) and other relevant data were documented on pre-defined data sheets.

Results:

The records of 343 patients were included in the study; 64.4% were male and 35.6% were female. The mean age was 59.3+13.6 (mean+SD) years for males, and 66.8+14.9 years for females. Small vessel occlusion was the most common etiologic subtype of ischemic stroke (32.1%), followed by cardio embolic (21.9%), and large artery atherosclerosis (14.6%). The middle cerebral artery was the most commonly affected territory. Hypertension was found in 78.1%, diabetes mellitus in 62.7%, hyperlipidemia in 54.8%, and ischemic heart disease in 24.2% of patients.

Conclusion:

Small vessel occlusion was the most common etiology in our cohort. The onset of stroke at a relatively younger age group in the male population is of great concern and needs to be verified by further epidemiological studies. Adequate control of modifiable risk factors may help in reducing the disease burden caused by stroke.

The epidemiology of stroke in the Middle East

Purpose

The purpose of this paper is to review and synthesize data from different countries in the Middle East on stroke and its potential risk factors.

Method

A systematic review of all published stroke articles in the Middle East between 1980 and May 2015 was conducted.

Findings

Sixty-four papers were included in the review. The incidence rate for all strokes ranged between 22.7 and 250 per 100,000 population per year. The prevalence rate for stroke ranged between 508 and 777 per 100,000 population. Among studies reporting gender differences, 75% reported a high male-to-female ratio among stroke patients. The mean age of stroke was within the sixth and the seventh decade. Ischemic stroke was the most reported type followed by intracerebral hemorrhage and subarachnoid hemorrhage. Hypertension was the most reported risk factor followed by diabetes. The overall case-fatality rate within one month was 12-32%.

Discussion

During the last decades, there was an increase in stroke incidence and mortality rates in the Middle East. The Middle East faces low rates of self-awareness and control of noncommunicable diseases and also lacks knowledge for stroke risk factors, awareness, causes, and symptoms.

Conclusion

There is an urgent need to develop more efficient and accurate methods to measure stroke in the Middle East. There is also a significant call to increase public awareness and implement interventions on stroke and its risk factors and symptoms to help people understand the negative impact of stroke on quality of life and potentially prevent this disease.

Influence of intracerebral hemorrhage location on incidence, characteristics, and outcome: population-based study

BACKGROUND AND PURPOSE

The characteristics of intracerebral hemorrhage (ICH) may vary by ICH location because of differences in the distribution of underlying cerebral small vessel diseases. Therefore, we investigated the incidence, characteristics, and outcome of lobar and nonlobar ICH.

METHODS

In a population-based, prospective inception cohort study of ICH, we used multiple overlapping sources of case ascertainment and follow-up to identify and validate ICH diagnoses in 2010 to 2011 in an adult population of 695 335.

RESULTS

There were 128 participants with first-ever primary ICH. The overall incidence of lobar ICH was similar to nonlobar ICH (9.8 [95% confidence interval, 7.7-12.4] versus 8.6 [95% confidence interval, 6.7-11.1] per 100 000 adults/y). At baseline, adults with lobar ICH were more likely to have preceding dementia (21% versus 5%; P=0.01), lower Glasgow Coma Scale scores (median, 13 versus 14; P=0.03), larger ICHs (median, 38 versus 11 mL; P<0.001), subarachnoid extension (57% versus 5%; P<0.001), and subdural extension (15% versus 3%; P=0.02) than those with nonlobar ICH. One-year case fatality was lower after lobar ICH than after nonlobar ICH (adjusted odds ratio for death at 1 year: lobar versus nonlobar ICH 0.21; 95% confidence interval, 0.07-0.63; P=0.006, after adjustment for known predictors of outcome). There were 4 recurrent ICHs, which occurred exclusively in survivors of lobar ICH (annual risk of recurrent ICH after lobar ICH, 11.8%; 95% confidence interval, 4.6%-28.5% versus 0% after nonlobar ICH; log-rank P=0.04).

CONCLUSIONS

The baseline characteristics and outcome of lobar ICH differ from other locations.

Stroke in Saudi Arabia: a review of the recent literature

Stroke is a major cerebrovascular disease resulting in high mortality and persistent disability in adults across the world. Besides coronary heart disease and cancer, stroke is the commonest cause of death in most industrialized countries. Survivors of stroke are often left with severe mental and physical disabilities, which create a major social and economic burden, ranking as the second most common cause of death worldwide and a major source of morbidity. The Kingdom of Saudi Arabia (KSA) is the largest country in the Middle East occupying approximately four-fifths of the Arabian Peninsula supporting a population of more than 28 million. Stroke is becoming a rapidly increasing problem and an important cause of illness and deaths in Saudi Arabia. However, compared with the developed countries, research regarding the incidence, prevalence and their socio-demographic properties of stroke is still insufficient due to lack of appropriate studies being conducted in these specified areas. This review aims to discuss the range of the aspect of stroke in Saudi Arabia from the literature published.

Transcranial Doppler ultrasonography in acute ischemic stroke predicts stroke subtype and clinical outcome: a study in Omani population

BACKGROUND

Transcranial Doppler ultrasonography (TCD) is being increasingly used for its ability to provide cerebral hemodynamic information in stroke. Few studies have explored its association with cerebral arteriographic changes and stroke subtype. This study explored the relation of TCD changes in acute stroke with stroke subtypes, MR cerebral arteriography and clinical outcome in Omani population.

METHODS

Adult patients presenting with acute ischemic stroke within 4 days of stroke onset were subjected to TCD through the temporal and suboccipital windows using a 2 MHz probe; flow velocities, pulsatility and direction of flow were recorded from arteries at the skull base. MR arteriographic (MRA) changes on corresponding arteries were graded on a scale of 1-4. ANOVA, student's t test and ROC analysis were used to evaluate TCD in relation to stroke type, outcome and stenosis on MRA.

RESULTS

Of 60 patients recruited, 52 (M:F::36:16; mean age: 60 + 13 years) had adequate bone window for TCD study. Large artery stroke occurred in 30 (58%) patients; lacunar stroke-11 (21%); cardioembolic and mixed groups 9 (17%), other specificed causes-2 (4%). 86.5% had evidence of intracranial disease. 10/52 patients (19%) died while 33 (63%) had good outcome (modified Rankin Score 0-3). Of the 186 arteries studied by the two methods, 52 had TCD evidence of stenosis while 42 were abnormal on MRA, giving a sensitivity of 60%, specificity: 81.25%; positive likelihood ratio: 3.18 and negative likelihood ratio: 0.5. 29/52 (56%) of patients had TCD changes in the arteries corresponding to stroke location. Abnormal TCD was associated with large artery strokes (p = 0.007), poor outcome (p = 0.038) and mortality (p = 0.01).

CONCLUSION

This study of TCD in acute stroke in Omani population demonstrates a relatively higher burden of intracranial arterial disease. TCD changes are associated with type of stroke and outcome in this population. TCD is a simple and fairly useful method of evaluation in patients with acute stroke. Adopting TCD in evaluation of stroke patients may provide useful information regarding the pathophysiology which could enhance patient management.

Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage?

OBJECTIVE

To determine whether evidence from observational studies supports the widely held belief that hypertension is more commonly a risk factor for deep than for lobar supratentorial intracerebral haemorrhage.

METHODS

Studies comparing the frequency of hypertension as a risk factor for deep versus lobar supratentorial intracerebral haemorrhage, excluding haemorrhages with identified secondary causes, were identified and subjected to a meta-analysis. The effects of predefined methodological quality criteria on the results were assessed and other sources of bias were considered.

RESULTS

The pooled result from all 28 included studies (about 4000 patients) found hypertension to be about twice as common in patients with deep as in those with lobar haemorrhage (odds ratio (OR) 2.10, 95% confidence interval (95% CI) 1.82 to 2.42), but there was significant heterogeneity between studies. The pooled OR was less extreme for studies that used a pre-stroke definition of hypertension, were population based or included first-ever strokes only. In the three studies meeting all criteria (601 patients), deep haemorrhage was associated with a smaller, statistically significant excess of hypertension (OR 1.50, 95% CI 1.09 to 2.07). The OR for studies confined to younger patients seemed to be more extreme (12.32, 95% CI 6.13 to 24.77), but none of these studies fulfilled our methodological quality criteria. Additional, unquantified sources of bias included uncertainty about whether those doctors reporting brain scans were blind to hypertension status, uncertain reliability of the classification of haemorrhage location and variable rates of investigation for secondary causes.

CONCLUSIONS

An excess of hypertension was found in patients with deep versus lobar intracerebral haemorrhages without an identified secondary cause, but this may be due to residual, unquantified methodological biases.

Injury to axons and oligodendrocytes following endothelin-1-induced middle cerebral artery occlusion in conscious rats

Injury to axons and oligodendrocytes has been poorly characterized in most animal models of stroke, and hence has been difficult to target therapeutically. It is therefore necessary to characterize axonal and oligodendroglial injury in these models, in order to rationally design putative protective compounds that minimize this injury. This study aims to characterize injury to axons and oligodendrocytes in the endothelin-1 (ET-1) model of middle cerebral artery occlusion (MCAO) in conscious rats. Transient forebrain ischemia was induced in conscious adult male Long Evans rats by the perivascular microinjection of ET-1. Quantitative histopathology was performed on forebrain sections at 6, 24, 48 and 72 h after ET-1 administration, using ballistic light analyses and immunohistochemistry for amyloid precursor protein (APP), SMI32, and Tau-1. Ballistic light analyses of cortical and striatal lesions revealed that the infarct volume was maximal in these regions by 6 h. APP and SMI32 immunohistochemistry demonstrated that axonal injury was maximal by 6 h in this model; however, some injured axons appeared to maintain good structural integrity up to 72 h after insult. Density measurements for Tau-1-immunopositive oligodendrocytes were significantly elevated within the corpus callosum from 48 h, but reductions in total oligodendrocyte numbers were not apparent up 72 h after ET-1 injection. These results indicate that axonal and oligodendroglial injury should be investigated as potential targets for delayed therapeutic intervention after MCAO.

The global burden of group A streptococcal diseases

The global burden of disease caused by group A streptococcus (GAS) is not known. We review recent population-based data to estimate the burden of GAS diseases and highlight deficiencies in the available data. We estimate that there are at least 517,000 deaths each year due to severe GAS diseases (eg, acute rheumatic fever, rheumatic heart disease, post-streptococcal glomerulonephritis, and invasive infections). The prevalence of severe GAS disease is at least 18.1 million cases, with 1.78 million new cases each year. The greatest burden is due to rheumatic heart disease, with a prevalence of at least 15.6 million cases, with 282,000 new cases and 233,000 deaths each year. The burden of invasive GAS diseases is unexpectedly high, with at least 663,000 new cases and 163,000 deaths each year. In addition, there are more than 111 million prevalent cases of GAS pyoderma, and over 616 million incident cases per year of GAS pharyngitis. Epidemiological data from developing countries for most diseases is poor. On a global scale, GAS is an important cause of morbidity and mortality. These data emphasise the need to reinforce current control strategies, develop new primary prevention strategies, and collect better data from developing countries.

Stroke in Saudi children

This study reports the clinical features and neuroimaging correlates of stroke in Saudi children seen over a 5-year period at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. During the study period, 31 (18 boys, 13 girls; mean age, 26.2 months) of the 20,895 children seen had stroke; the annual stroke incidence was 29.7 per 100,000 in the pediatric population. Ischemic strokes accounted for 90% and hemorrhagic 10% of the cases, respectively. The boys-to-girls ratio for ischemic stroke was 2:1. Cranial computed tomographic scans and magnetic resonance imaging findings were abnormal in 82% and 91%, respectively. The etiologic factor was undetermined in 65% of the cases. Our results suggest that stroke is uncommon in Saudi children. However, further studies evaluating a larger population in different clinical settings are required to provide a more comprehensive picture of stroke in children in this area.

Hematological values and their assessment as risk factor in Saudi patients with stroke

The retrospective analysis of hematological data on 500 consecutive Saudi patients (342;158F) (mean age 63 +/- 17 yrs) with stroke whose composition was: large infarctions 260 (52%); lacunar infarctions 121 (24.2%), intracerebral hemorrhage 107 (21.2%) and subarachnoid hemorrhage 12 (2.4%), showed that RBC (5.2 +/- 1.9 x 10(12)/L), Hb (143 +/- 21 g/l) and Hct (0.43 +/- 0.07 1/1) values were significantly higher (P < 0.001) in patients with large infarctions as compared to other types of strokes. In both male and female groups of patients, the most likely stroke prone age was 61 to 70 years and interestingly the levels of above three parameters increased or dropped after a certain age. The highest values were in the 61-70 yr age group with men being higher than women (P < 0.001). The overall mortality rate was about 20%, but it was higher in the group of patients with large infarction (63/260; 24.3%). Of these 13 were below the age of 60 years and the remaining 50 aged > 60 included 28 patients (20M;8F) who had Hb > 140 g/l suggesting that Hb > 150 g/L or Hct > 0.44 in men and > 140 g/l or Hct > 0.42 in women is probably a risk factor for having cerebral infarctions and increased mortality. Since this study is neither a cohort nor prospective and was not performed in the acute phase, it was difficult to ascertain if relative polycythemia was a primary event for stroke or was secondary to dehydration in which Saudi hot weather may be a contributory factor.

Stroke in children: a study of 21 cases from Saudi Arabia

Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending two large hospitals in Saudi Arabia over a 10-year period. The number constitutes two per cent of all cases of stroke managed in these hospitals during that period. Eleven cases were associated with cerebral arterial infarction, nine with cerebral haemorrhage and one with venous infarction. The main aetiological factors were attributable to embolism of cardiac origin, infections, coagulation disorders, haemoglobinopathies and arteriovenous malformations. Although stroke in children is regarded as rare, its relative frequency in Saudi society is probably higher than in western societies.

Stroke in a Saudi Arabian National Guard community. Analysis of 500 consecutive cases from a population-based hospital

BACKGROUND AND PURPOSE

We sought to determine the crude incidence rate, patterns, and risk factors associated with different types of stroke in a defined Saudi population.

METHODS

Records of 500 (342 male, 158 female) consecutive patients with first-ever stroke admitted from December 1982 to June 1992 in a hospital that exclusively serves the Saudi Arabian National Guard community were reviewed. Diagnosis was confirmed by brain computed tomography, and the most likely etiology was determined on the basis of relevant clinical, radiological, and laboratory data.

RESULTS

The mean age of the patients was 63 +/- 17 years. Males predominated in all types of stroke (P < .001). The crude annual incidence rate was 43.8 per 100,000. Ischemic strokes accounted for 76.2%, and these included 52% with large and 24.2% with lacunar infarctions. Intracerebral hemorrhage was detected in 21.4%, whereas subarachnoid hemorrhage was rare (2.4%). Hypertension (56%), diabetes mellitus (42%), and cardiopathy (33%) were common risk factors. Sixty-one patients (12%) died during the first month after their stroke.

CONCLUSIONS

The study suggests that stroke incidence is low in Saudi Arabia compared with industrialized countries, which could be because of the predominance of young age groups. The overall distribution of stroke types was closer to that of Western populations than to the Japanese, in whom hemorrhagic strokes are highly prevalent. However, the high combined frequencies of lacunar infarctions and intracerebral hemorrhages suggest that disease of the small cerebral arteries played a more important role in Saudis than in Western populations.

Binswanger disease: The King Khalid University Hospital experience

Two hundred and twenty-one Saudi patients admitted for stroke in King Khalid University Hospital between 1982 and 1987 were evaluated clinically and by laboratory and radiological investigations. Twelve patients were found to have leukoraiosis on brain CT and a clinical picture compatible with Binswanger disease (subcortical arteriosclerotic encephalopathy). Arterial hypertension was present in all cases, seizure disorders in 25%, and dementia in 83%. The features of these cases are compared with similar cases reported from other places. The importance of control of hypertension in prevention of Binswanger disease is emphasized.