• it’s actually a syndrome
  • synonyms are:
    • 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
  • it usually manifests in individuals older than 50y of age and is caused by arteriolopathy, typically in long-lasting and poorly corrected hypertension
  • clinically dominates a progressive motor impairment and vascular cognitive deficit (VCI)

Etiology

  • arteriolopathy, atherosclerosis, thromboembolism
    • small penetrating arteries which thickened, lipohyalinised, stenotic, or occluded
  • 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

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
    • lesions are more pronounced on MRI compared to CT
    • scales to assess the extent of the white matter lesion on MRI
Binswanger´s disease

Binswanger´s disease (FLAIR, coronary plane)

Extensive leukoencephalopathy in Binswanger´s disease (FLAIR)
Binswanger´s disease (CT and FLAIR)

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 arterial hypertension treatment
  • aggressive treatment of other vascular risk factors (typically diabetes, hyperlipidemia etc.)

Symptomatic therapy

  • symptomatic psychiatric therapy
    • antidepressants
    • anxiolytic drugs
    • hypnotic drugs
  • cognitive enhancers – cholinergic deficiency is assumed in VaD (vascular dementia)
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