Editorial |

New Insight Into Binswanger Disease

Gustavo C. Román, MD, FRSM
Arch Neurol. 1999;56(9):1061-1062. doi:10.1001/archneur.56.9.1061.
Text Size: A A A
Published online


BINSWANGER DISEASE is a well-established clinical pathological entity1 characterized by an ischemic periventricular leukoencephalopathy that typically spares the arcuate subcortical U fibers and is manifested clinically by subcortical frontal executive dysfunction, parkinsonian gait disturbances, urinary incontinence, mood changes, and pseudobulbar palsy.2 Binswanger disease is one of the most common forms of vascular dementia in the elderly.3 However, intense controversy still surrounds its clinical manifestations, pathophysiology, and prevalence.4 Unfortunately, as noted by Caplan,2 "dispute over the name of the condition has diverted attention away from more important issues." In addition to the descriptive but cumbersome periventricular leukoencephalopathy, a dozen other synonyms have been proposed to name Binswanger-type white-matter lesions.5 Currently, the concise term leukoaraiosis (Greek for white rarefaction) is widely used. Proposed initially as a noncommittal, purely descriptive radiological term, leukoaraiosis is used to describe the white-matter hypodensities seen on brain computed tomographic scans.5,6 Nonetheless, these lesions are usually visualized as hyperintensities on magnetic resonance imaging scans,7,8 rendering the name irrelevant. More unfortunately, leukoaraiosis is often used interchangeably with Binswanger disease. The use of this term in this sense should be discouraged, since "leukoaraiosis is neither a disease nor even a specific indicator of white-matter ischemia,"4 and one can hardly study the pathophysiologic characteristics, symptoms, and natural history of a radiologic image.9 It is currently accepted that Binswanger-type leukoencephalopathy is caused by hypoxia-ischemia of distal watershed periventricular territories,9,10 the combined effects of arteriolosclerosis and elongation of medullary arterioles, dilatation of the perivascular spaces (état criblé), and decreased brain perfusion from hypotension or low cardiac output. The most important single risk factor appears to be aging of cerebral arterioles.11,12 In the Cardiovascular Health Study,13 about one third of subjects aged 65 years and older showed Binswanger-type white-matter lesions on magnetic resonance imaging scans. The severity of the lesions increased with age, hypertension, silent lacunar strokes, hypotension, smoking, and low income, the latter risk factor being a probable surrogate for limited access to medical care, inadequate diet, and poor control of hypertension.14 The effects of sustained daytime arterial hypertension, hypertensive crises, and the absence of a normal nocturnal dip in blood pressure (nondipping) are particularly damaging.15,16

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 10

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles