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Binswanger's encephalopathy: a review

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Summary

Binswanger's encephalopathy is reviewed in respect to history, computed tomography, magnetic resonance imaging, epidemiology, pathology, clinical picture, laboratory findings, differential diagnosis, and treatment. The various viewpoints on the pathogenesis of the process are discussed, in particular the role of ischemia, vascular disease, high blood pressure, lacunar infarction, hypoxia, edema, and hydrocephalus. The white matter hypomyelination of congophilic angiopathy and Alzheimer's disease should provide clues. A unifying hypothesis has not been attained.

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Abbreviations

AD:

Alzheimer's disease

BE:

Binswanger's encephalopathy

BP:

blood pressure

CA:

congophilic angiopathy

CSF:

cerebrospinal fluid

CT:

computed tomography

EEG:

electroencephalography

HU:

Hounsfield units

ISL:

incidental subcortical lesions

LD:

low density

MR:

magnetic resonance imaging

NPH:

normal pressure hydrocephalus

PV:

periventricular

PVH:

periventricular hyperintensity in MR, including capping and rimming

PVLD:

periventricular low density in CT

PVWM:

periventricular white matter

TIA:

transient ischemic attack

UBOs:

unidentified bright objects

U fibers:

arcuate fibers

WM:

white matter

WMHF:

white matter hyperintense foci in MR

WMLD:

white matter low density

References

  1. Alzheimer A (1902) Die Seelenstörung auf arteriosclerotischer Grundlage. Z Psychiatr 59:695–711

    Google Scholar 

  2. Antunes IL (1952) Lésions de la substance blanche dans l'artériosclérose cerébral. Proceedings of the First International Congress of Neuropathologists, Rome, vol 3. Rosenberg and Sellier, Torino, pp 199–205

    Google Scholar 

  3. Aronson SM, Perl DP (1974) Clinical neuropathological conference. Dis Nerv Syst 35:286–291

    Google Scholar 

  4. Asada M, Tamaki N, Kanazawa Y, Matsumoto M, Kimura S, Fujii S, Kaneda Y (1978) Computer analysis of periventricular lucency on the CT scan. Neuroradiology 16:207–211

    Google Scholar 

  5. Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 17:1084–1089

    Google Scholar 

  6. Awad IA, Johnson PC, Spetzler RF, Hodak JA (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological findings. Stroke 17:1090–1097

    Google Scholar 

  7. Babikian V, Ropper AH (1987) Binswanger's disease: a review. Stroke 18:2–12

    Google Scholar 

  8. Behring EA (1962) Circulation of the cerebrospinal fluid. J Neurosurg 19:405–413

    Google Scholar 

  9. Biemond A (1970) On Binswanger's subcortical arteriosclerotic encephalopathy and the possibility of its clinical recognition. Psychiatr Neurol Neurochir 73:413–417

    Google Scholar 

  10. Binswanger O (1894) Die Abgrenzung des allgemeinen progressiven Paralysie. Klin Wochenschr 31:1103–1105, 1137–1139, 1180–1186

    Google Scholar 

  11. Bradley WG, Waluch V, Brant-Zawadzki M, Yadley RA, Wycoff RR (1984) Patchy periventricular white matter lesions in the elderly: a common observation during NMR imaging. Non-Invasive Med Imaging 1:35–41

    Google Scholar 

  12. Brant-Zawadzki M, Fein G, Van Dyke C, Kiernan R, Davenport L, de Groot J (1985) MR imaging of the aging brain: patchy white matter lesions and dementia. Am J Neuroradiol 6:675–682

    Google Scholar 

  13. Brun A, Englund E (1986) The white matter disorder in dementia of the Alzheimer type: a pathoanatomical study. Ann Neurol 19:253–262

    Google Scholar 

  14. Burger PC, Burch JG, Kunze U (1976) Subcortical arteriosclerotic encephalopathy (Binswanger's disease). Stroke 7:626–631

    Google Scholar 

  15. Byrom FB (1954) The pathogenesis of hypertensive encephalopathy and its relation to the malignant phase of hypertension: experimental evidence from the hypertensive rat. Lancet II:201–211

    Google Scholar 

  16. Caplan L (1974) The clinical features of subcortical arteriosclerotic encephalopathy. Neurology 24:374

    Google Scholar 

  17. Caplan LR (1985) Binswanger's disease. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 46. Neurobehavioural disorders. Elsevier, New York, pp 317–321

    Google Scholar 

  18. Caplan LR, Schoene WC (1978) Clinical features of subcortical arteriosclerotic encephalopathy (Binswanger's disease). Neurology 28:1206–1215

    Google Scholar 

  19. Davidoff LM, Dyke CG (1951) Normal encephalogram, 3rd edn. Lea and Febiger, Philadelphia

    Google Scholar 

  20. DeLeon MJ, George AE, Ferris SH, Gentes CI, Christman DR, Fowler J, Budzilovich G, London E, Miller JD, Reisberg B, Wolf AP (1985) CT and PET study of leukoencephalopathy in Alzheimer's disease. Am J Neuroradiol 6:468

    Google Scholar 

  21. DeReuck JL (1971) The human periventricular arterial blood supply and the anatomy of cerebral infarctions. Eur Neurol 5:321–334

    Google Scholar 

  22. DeWitt LD, Kistler JP, Miller DC, Richardson EP, Buonanno FS (1987) NMR-Neuropathologic correlation in stroke. Stroke 18:342–351

    Google Scholar 

  23. Dougherty JH, Simmons JD, Parker J (1986) Subcortical ischemic disease: clinical spectrum and MRI correlation. Stroke 17:146

    Google Scholar 

  24. Dubas F, Gray F, Roullet E, Escourolle R (1985) Leucoencéphalopathies artériopathiques. Rev Neurol (Paris) 141:93–108

    Google Scholar 

  25. Dupuis M, Brucher JM, Gonsette RE (1984) Observation anatomoclinique d'une encephalopathie sous-corticale arteriosclereuse avec hypodensité de la substance blanche au scanner cerebral. Acta Neurol Belg 84:131–140

    Google Scholar 

  26. Earnest MP, Fahn S, Karp JH, Rowland LP (1974) Normal pressure hydrocephalus and hypertensive cerebrovascular disease. Arch Neurol 31:262–266

    Google Scholar 

  27. Ekbom K, Greitz T, Kalmer M, Lopez J, Ottosson S (1969) Cerebrospinal fluid pulsations in occult hydrocephalus due to ectasia of basilar artery. Acta Neurochir 20:1–8

    Google Scholar 

  28. Erkinjuntti T, Sipponem JT, Iivanainen M, Ketonen L, Sulkava R, Sebbonen RE (1984) Cerebral NMR and CT imaging in dementia. J Comput Assist Tomogr 8:614–618

    Google Scholar 

  29. Evans WA Jr (1942) An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatr 47:931–937

    Google Scholar 

  30. Feigin I, Popoff N (1963) Neuropathological changes late in cerebral edema: the relationship of trauma, hypertensive disease and Binswanger's encephalopathy. J Neuropathol Exp Neurol 22:500–511

    Google Scholar 

  31. Feigin I, Budzilovich G, Weinberg S, Ogata J (1973) Degeneration of white matter in hypoxia acidosis and edema. J Neuropathol Exp Neurol 32:125–143

    Google Scholar 

  32. Fisher CM (1965) Lacunes: small deep cerebral infarcts. Neurology 15:774–784

    Google Scholar 

  33. Fisher CM (1969) The arterial lesions underlying lacunes. Acta Neuropathol (Berl) 12:1–15

    Google Scholar 

  34. Garcin R, Lapresle J, Lyon G (1960) Encéphalopathie sous-corticale chronique de Binswanger: étude anatomo-clinique de trois observations. Rev Neurol (Paris) 102:423–440

    Google Scholar 

  35. George AE, DeLeon M, Miller J, Englund E, Ferris S, Gentes CI, London E, Budzilovich G, Chase N (1984) Leukoencephalopathy of aging. I. CT-clinical-neuropathologic study of brain lucencies. Am J Neuroradiol 5:678

    Google Scholar 

  36. George AE, DeLeon MJ, Foo SH, Miller J, Ferris SH, Christman DR, Wolf A (1985) The differentiation of communicating hydrocephalus from atrophy using positron emission tomography (PET). Am J Neuroradiol 6:468

    Google Scholar 

  37. George AE, DeLeon MJ, Gentes CI, Miller J, London E, Budzilovich GN, Ferris S, Chase N (1986) Leukoencephalopathy in normal and pathologic aging. I. CT of brain lucencies. Am J Neuroradiol 7:561–566

    Google Scholar 

  38. George AE, DeLeon MJ, Kalnin A, Rosner L, Goodgold A, Chase N (1986) Leukoencephalopathy in normal and pathologic aging. 2. MRI of brain lucencies. Am J Neuroradiol 7:567–570

    Google Scholar 

  39. Goto K, Ishii N, Fukasawa H (1981) Diffuse white-matter disease in the geriatric population: a clinical, neuropathological and CT study. Radiology 141:678–695

    Google Scholar 

  40. Gray F, Dubas F, Roullet E, Escourolle R (1985) Leukoencephalopathy in diffuse hemorrhagic cerebral amyloid angiopathy. Ann Neurol 18:54–59

    Google Scholar 

  41. Greitz T (1969) Effect of brain distension on cerebral circulation. Lancet I:863–865

    Google Scholar 

  42. Hachinski VC, Potter P, Merskey H (1987) Leuko-araiosis. Arch Neurol 44:21–23

    Google Scholar 

  43. Huang K, Wee L, Luo Y (1985) Binswanger's disease: progressive subcortical encephalopathy or multi-infarct dementia? Can J Neurol Sci 12:88–94

    Google Scholar 

  44. Hunt AL, Orrison WW, Rhyne R, Garry PS, Rosenberg GA (1988) Significance of white matter lesions in MRI in the elderly. Neurology 38 [Suppl 1]:371

    Google Scholar 

  45. Jacob H, Iizuka R, Lütcke A (1972) Präsenile leukencephalopathische Hydrocephalie. Z Neurol 202:64–74

    Google Scholar 

  46. James AE, Strecker E-P, Sperber E, Flor WJ, Merz T, Burns B (1974) An alternative pathway of cerebrospinal fluid absorption in communicating hydrocephalus. Radiology 111:143–146

    Google Scholar 

  47. Janota I (1981) Dementia, deep white matter damage and hypertension: “Binswanger's disease.” Psychol Med 11:39–48

    Google Scholar 

  48. Jelgersma HC (1964) A case of encephalopathia subcorticalis chronica (Binswanger's disease). Psychiatr.-Neurol 147:81–89

    Google Scholar 

  49. Jellinger K, Neumayer E (1964) Progressive subcorticale vasculare encephalopathie Binswanger: eine klinisch-neuropathologische Studie. Arch Psychiatr Z Gesamte Neurol 205:523–554

    Google Scholar 

  50. Johnson KA, Davis KR, Buonanno FS, Brady TJ, Rosen J, Growdon JH (1987) Comparison of magnetic resonance and roentgen ray computed tomography in dementia. Arch Neurol 44:1075–1080

    Google Scholar 

  51. Kertesz A, Black SE, Tokar G, Benke T, Carr T, Nicholson L (1988) Periventricular and subcortical hyperintensities on magnetic resonance imaging. Arch Neurol 45:404–408

    Google Scholar 

  52. Kinkel WR, Jacobs L, Polachini I, Bates V, Heffner RR (1985) Subcortical arteriosclerotic encephalopathy (Binswanger's disease). Arch Neurol 42:951–959

    Google Scholar 

  53. Loizou LA, Kendall BE, Marshall J (1981) Subcortical arteriosclerotic encephalopathy: a clinical and radiologic investigation. J Neurol Neurosurg Psychiatry 44:294–304

    Google Scholar 

  54. Loizou LA, Jefferson JM, Smith WT (1982) Subcortical arteriosclerotic encephalopathy (Binswanger's type) and cortical infarcts in a young normotensive patient. J Neurol Neurosurg Psychiatry 45:409–417

    Google Scholar 

  55. Lotz PR, Ballinger WE, Quisling RG (1986) Subcortical arteriosclerotic encephalopathy: CT spectrum and pathologic correlation. Am J Neuroradiol 7:817–822

    Google Scholar 

  56. Mascalchi M, Ciraolo L, Tanfani G, Taverni N, Siracusa GF, Dal Pozzo GC, Inzitari D (1988) Aqueductal CSF flow study by cardiac-gated phase-encoded MR imaging. Neurology 38 [Suppl 1]:139

    Google Scholar 

  57. Mascalchi M, Inzitari D, Marini P, Giordano GP, Abbamondi AL (1988) Leuko-araiosis and Binswanger's disease: a CT-pathological study. Neurology 38 [Suppl 1]:372

    Google Scholar 

  58. Mikol J (1968) Maladie de Binswanger et formes apparentées: contribution à l'étude des leucoencéphalopathies arterioscléreuses. Rev Neurol (Paris) 118:111–132

    Google Scholar 

  59. Morgello S, Farrar JT, Heier LA (1988) Periventricular hyperintense lesions on magnetic resonance scans. Neurology [Suppl 1] 38:139

    Google Scholar 

  60. Mori K, Murata T, Nakano Y, Handa H (1977) Periventricular lucency in hydrocephalus on computerized tomography. Surg Neurol 8:337–340

    Google Scholar 

  61. Naheedy MH, Gupta SR, Young JC, Ghobrial M, Rubino FA, Ross ER, Hindo W (1985) Periventricular white matter changes and subcortical dementia: clinical, neuropsychological, radiological and pathological correlation. Am J Neuroradiol 6:468

    Google Scholar 

  62. Nichols FT, Mohr JP (1986) Binswanger's subacute arteriosclerotic encephalopathy. In: Barnett HJM, Mohr JP, Stein BM (eds) Stroke, vol 2. Pathophysiology, diagnosis and management. Churchill Livingstone, New York, pp 875–885

    Google Scholar 

  63. Okeda R (1973) Morphometrische Vergleichsuntersuchungen an Hirnarterien bei Binswangerscher Encephalopathie und Hochdruckencephalopathie. Acta Neuropathol (Berl) 26:23–43

    Google Scholar 

  64. Olszewski J (1962) Subcortical arteriosclerotic encephalopathy: review of the literature on the so-called Binswanger's disease and presentation of 2 cases. World Neurol 3:359–375

    Google Scholar 

  65. Pullicino C, Eskin T, Ketonen L (1983) Prevalence of Binswanger's disease. Lancet I:939

    Google Scholar 

  66. Rezek DL, Morris JC, Fulling KH, Gado MH (1987) Periventricular white matter lucencies in senile dementia of the Alzheimer type and in normal aging. Neurology 37:1365–1368

    Google Scholar 

  67. Roman GC (1987) Senile dementia of the Binswanger type: a vascular form of dementia in the elderly. JAMA 258:1782–1788

    Google Scholar 

  68. Rosenberg GA, Kornfeld M, Stovring J, Bicknell J (1979) Subcortical arteriosclerotic encephalopathy (Binswanger): computerized tomography. Neurology 29:1102–1106

    Google Scholar 

  69. Shelburne SA, Blain O, O'Hare JP (1932) The spinal fluid in hypertension. J Clin Invest 11:489–496

    Google Scholar 

  70. Steingart A, Hachinski VC, Lau C, Fox AJ, Fox H, Lee D, Inzitari D, Merskey H (1987) Cognitive and neurologic findings in subjects with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis). Arch Neurol 44:32–35

    Google Scholar 

  71. Steingart A, Hachinski VC, Lau C, Fox AJ, Fox H, Lee D, Inzitari D, Merskey H (1987) Cognitive and neurologic findings in demented patients with diffuse white matter lucencies on computed tomographic scan (leuko-araiosis). Arch Neurol 44:36–39

    Google Scholar 

  72. Stochdorph O, Meesen H (1957) Die arteriosklerotische und die hypertonische Hirnerkrankung. In: Scholz W (ed) Handbuch der speziellen pathologischen Anatomie und Histologie, vol 13/1B. Springer, Berlin Göttingen Heidelberg, pp 1167–1510

    Google Scholar 

  73. Tomonaga M, Yamanouchi H, Tohgi H, Kameyama M (1982) Clinicopathologic study of progressive subcortical vascular encephalopathy (Binswanger type) in the elderly. J Am Geriatr Soc 30:524–529

    Google Scholar 

  74. Valentine AR, Moseley IF, Kendall BE (1980) White matter abnormality in cerebral atrophy: clinicoradiological correlations. J Neurol Neurosurg Psychiatry 43:139–142

    Google Scholar 

  75. Vinters HV, Gilbert JJ (1983) Cerebral amyloid angiopathy: incidence and complications in the aging brain. II. The distribution of amyloid vascular changes. Stroke 14:924–928

    Google Scholar 

  76. Yamada F, Fukuda S, Samejima H, Yoshii N, Kudo T (1978) Significance of pathognomonic features of normal-pressure hydrocephalus on computerized tomography. Neuroradiology 16:212–213

    Google Scholar 

  77. Zatz LM, Jernigan TL, Ahumada AJ (1982) White matter changes in cerebral computed tomography related to aging. J Comput Assist Tomogr 6:19–23

    Google Scholar 

  78. Zeumer H, Schonsky B, Sturn KW (1980) Predominant white matter involvement in subcortical arteriosclerotic encephalopathy (Binswanger disease). J Comput Assist Tomogr 4:14–19

    Google Scholar 

  79. Zimmerman RD, Fleming CA, Lee BCP (1986) Periventricular hyperintensity as seen by magnetic resonance: prevalance and significance. Am J Neuroradiol 7:13–20

    Google Scholar 

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  1. Department of Neurology, Massachusetts General Hospital, 02114, Boston, MA, USA

    C. Miller Fisher

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Miller Fisher, C. Binswanger's encephalopathy: a review. J Neurol 236, 65–79 (1989). https://doi.org/10.1007/BF00314400

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  • DOI: https://doi.org/10.1007/BF00314400

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