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.
Synonyms:
Binswanger disease a.k.a. subcortical arteriosclerosis encephalopathy:
Diagnosis:
MRI
- 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
Pathology:
- Affects: subcortical white matter bilaterally more severe periventricularly
Microscopically:
- 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.