Binswanger's disease is not a single entity

Abstract

The clinicopathological findings reported by Binswanger are insufficient to qualify as distinct entity the condition named “Binswanger's disease”, and subsequently by Olszewski (1962) “subcortical arteriosclerotic encephalopathy (SAE) (Binswanger's type)”. A short summary of the characteristic pathological, clinical and neuroimaging features of SAE is reported. The white matter changes detected by neuroimaging must be considered aspecific, since identical changes may be found in normal elderly as well as in patients with different diseases: different biochemical mechanisms can undoubtedly underlie identical neuroimaging patterns. Two other relevant points are noteworthy: the occurrence of pathological features of SAE in other diseases (CADASIL, pseudoxanthoma elasticum, antiphospholipid antibody syndrome) and the observation of some patients with pathological changes of SAE but an incomplete clinical picture. The clinicopathological features described as Binswanger's disease do not qualify as a separate entity since they are common to variety of illnesses. The pathological picture identified by Olszewski can rightly be named, according to Caplan, “chronic microvascular leukoencephalopathy” (CML). The clinicopathological features of the so-called Binswanger's disease constitute a syndrome, the CML syndrome (CMLS), which can be found in some hereditary diseases and in acquired conditions. This syndrome shows peculiar cerebrovascular changes and, when clinically associated with dementia, identifies one of the subtypes of vascular dementia.