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55 APRIL 2007
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Pictorial CME

BinswangerÊs Disease
75 years male, a known case of hypertension (uncontrolled, not on drugs) was admitted with history
of gait
disturbances for the last three years. On examination his BP was 170/110 mmHg, fundus was
suggestive of grade
2 hypertensive retinopathy. In CNS examination, his MMSE was 20/30, he was having slight
weakness of all four
limbs (Power 4/5), his reflexes were brisk, bilateral cerebellar signs were present (right > left) and his
posterior
column sensations were impaired. CT scan head showed moderate cerebral atrophy and
periventricular lucency.
The MRI showed bilateral hyperintensities on T2- weighted sequences in periventricular location, in
corona radiata
and lentiform nucleus and confluent hyperintensities in sagittal section along corpus callosum. The
diagnosis of
BinswangerÊs disease (subcortical arteriosclerotic encephalopathy) is kept.
Dementia associated with cerebrovascular disease can be divided into two categories
multiinfarct dementia and
diffuse white matter disease (Binswanger). This disorder is microangiopathy due to occlusive disease
of small
penetrating cerebral arteries and arterioles. First described in 1894 by Prof. Binswanger, the criteria
for diagnosis
include
1
dementia (subcortical), bilateral radiological abnormalities on CT or MRI, and at least two of the
following
three clinical findings : A) A vascular risk factor or evidence of systemic vascular disease e.g. HTN,
CAD; B) Evidence
of focal cerebrovascular disease e.g stroke; and c) Evidence of subcortical cerebral dysfunction e.g.
abnormal gait.
Most important risk factor appears to be ageing of cerebral arterioles. Age of onset is typically in 6
th
or 7
th
decades
of life. Hypertension, diabetes mellitus, previous cerebrovascular accidents are associated risk
factors. In 1/3
rd
of
patients, the onset of disease is sudden with acute neurological deficits consistent with a diagnosis of
stroke. 2/3
rd
of
cases begin slowly and insidiously. The gradual progression of memory loss is most commonly
reported symptom.
2
Characteristic neuroimaging findings of Binswanger Ês disease include areas of non contrasting
hypodensities that
are nearly symmetric in the periventricular white matter on CT and hyperintensities on T
2
- weighted images in MRI.
These changes are often called „leukoaraiosis‰.
3
Other causes of leukoaraiosis include multiple sclerosis, progressive
multifocal leukoencephalopathy, acute disseminated encephalomyelitis, leukodystrophies, normal
pressure
hydrocephalus and normal ageing pattern. Clinical picture helps to differentiate these causes of
leukoaraiosis from
each other, as well as some typical neuroimaging findings. No treatment is known to reverse or cure
Binswanger Ês
disease, control of high blood pressure and Aspirin prophylaxis may be helpful.

(11) (PDF) Binswanger's disease. Available from:

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2018].