Subcortical Arteriosclerosis Encephalopathy

Now considered a subtype of Subcortical Vascular Dementia when cognitive dysfunction is present. It is the result of longstanding small vessel disease, particularly due to uncontrolled hypertension.


Binswanger disease a.k.a. subcortical arteriosclerosis encephalopathy:



  • T2/FLAIR: subcortical white matter hyperintensities in confluent areas (initially multifocal), more prominant periventricularly, usually with evidence of previous lacunar infarctions
  • GRE: often there are microhemorrhages
  • T1 plus GAD: White matter disease does not enhance


  • Affects: subcortical white matter bilaterally more severe periventricularly


  • Hypertensive lacunes, myelin loss, oligodendroglial loss, microcystic cavities, myelin sheath swelling, gliosis.
  • Hyaline arteriolosclerosis= concentric thickening of small arteries & arterioles +widening of perivascular space.
  • Lipohyalinosis (fibrinoid necrosis & hyalinisation)= vessens between 40-300 mm in diameter.

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