ISCHEMIC STROKE
Binswanger’s disease
Created 18/02/2022, last revision 21/04/2023
- Binswanger’s disease is a progressive neurological disorder characterized by ischemic involvement of the white matter and deep brain structures (basal ganglia and thalamus)
- usually can be seen in individuals over 50 years of age and is caused by small vessel disease and branch artery atherosclerosis
- typically in individuals with long term and poorly corrected hypertension and other vascular risk factors
- clinically characterized by a progressive motor impairment and vascular cognitive deficit (VCI)
- synonyms used in the literature:
- Binswanger’s encephalopathy
- subcortical leukoencephalopathy
- multi-infarct or vascular dementia of the Binswanger type
- subcortical ischemic vascular disease
- subcortical arteriosclerotic encephalopathy (SAE)
- small vessel dementia
Etiology
- arteriolopathy, atherosclerosis, thromboembolism
- mostly small penetrating artery disease
- mostly small penetrating artery disease
- lesions are relatively symmetrical and diffuse – deep periventricular white matter lesions + lacunar infarcts in basal ganglia, thalamus, and brainstem (pons)
Clinical presentation
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Diagnostic evaluation
- typical clinical presentation and imaging findings +vascular risk factors (especially hypertension)
Imaging methods
- CT: symmetrical hypodensities in deep white matter + lacunar infarcts + atrophy
- MRI (FLAIR, T2): extensive periventricular and subcortical white matter lesions + subcortical lacunar infarcts + atrophy
Differential diagnosis
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Management
Prevention of cerebrovascular disease
- the disease is irreversible; therapy may slow down or stop the progression
- antiplatelet or anticoagulant therapy
- aggressive treatment of arterial hypertension
- aggressive treatment of other vascular risk factors (e.g., diabetes, hyperlipidemia, etc.)
Symptomatic therapy
- symptomatic psychiatric therapy
- antidepressants
- anxiolytic drugs
- hypnotic drugs
- cognitive enhancers – cholinergic deficiency is assumed in VaD (vascular dementia)
- studies have shown some effects of both donepezil and rivastigmine Black, 2003][Birks, 2013]
