Binswanger disease (BD) is a distinct form of vascular dementia in which atherosclerosis and hypertension affecting the smaller blood vessels in the white matter cause a slowly progressive ischemia of the subcortical areas of the brain[1] [2] [3]. Hypertensive vascular disease is, by far, the single most important risk factor for the development of BD, and many individuals report prior episodes of stroke or transient ischemic attacks (TIAs), whereas diabetes mellitus, pre-diabetic states, cigarette smoking, hyperlipidemia and sleep apnea are mentioned in certain reports as well [1] [4]. Progressive reduction of blood flow through these areas explains the gradual course of BD, and the initial symptoms are related to alterations in cognitive status - decline in executive functions, reduction in the speed of processing information and memory dysfunction [1] [2] [5] [6]. Moreover, deficits in attention, behavioral changes and emotional lability are clinical hallmarks of BD and other forms of dementia [3] [5]. In addition, focal neurological deficits are commonly observed, most prominent being those involving the upper motor neurons (UMNs) - muscle rigidity, hyperreflexia (often asymmetric), signs of parkinsonism, ataxia and gait disturbances [1] [2] [3] [6]. Urinary incontinence is reported in many individuals as well [4] [6].

• Progressive Dementia

  The other 15 patients had neurologic deficits that presented in one of three ways: (1) stroke, seven patients; (2) slowly progressive dementia and gait disturbance, five patients; or (3) slowly progressive dementia alone, three patients. [jamanetwork.com]

  The main clinical manifestations of progressive dementia. 【clinical points] 1. 2/3. chronic disease, and 1/3 for the acute onset. [e.uuuwell.com]

  Definition Binswanger disease is a rare form of progressive dementia that develops after age 60 and involves degeneration of the brain's white matter. [encyclopedia.com]

  Intermittent and fluctuating neurological signs - often appearing at intervals of several years - as well as a slowly progressing dementia, can be a clinical indication of SAE, especially in patients who have been known to suffer from hypertension for [thieme-connect.com]

  Types of Lewy body dementia include: Dementia with Lewy bodies (DLB), one of the more common forms of progressive dementia. [alzheimersweekly.com]

• Lower Extremity Pain

  As the disease progresses, especially in case of complications, the symptoms gradually increased and obvious, such as fingers numb and stiff lower extremity pain, walking, or the back of the neck muscle soreness tension. [e.uuuwell.com]

• Lymphedema

  Omental transposition in the control of chronic lymphedema. JAMA. 2008. 203: 1111-21 9. Goldsmith HS. Lack of atherosclerosis in omental arteries. Lancet. 1990. 335: 409- 10. Goldsmith HS, Bassiu P, Cosso M, Pau A, Rodriguez G, Rosadini G. [surgicalneurologyint.com]

• Euphoria

  Patients may become emotionally labile and unpredictable, demonstrating euphoria or aggression. Severe depression occurs in 20 percent of cases, and suicide attempts have been reported. [aafp.org]

• Loss of Attention

  Symptoms of Binswanger disease include short-term memory loss, short attention span, inappropriate behaviors, inability to make decisions, change in mood and personality, an unsteady gait, clumsiness or frequent falls and a decrease in organizational [theadvocate.com]

• Urinary Incontinence

  Clinically, Lacunar Dementia presents with gait difficulties, urinary incontinence, parkinsonian features, pseudobulbar palsy, emotional incontinence and dementia. [ncbi.nlm.nih.gov]

  […] the cardiovascular system Arteriosclerosis of small cerebral arteries Abnormality of the genitourinary system Urinary incontinence Abnormality of the integument Alopecia Abnormality of the nervous system Arteriosclerosis of small cerebral arteries Ataxia [familydiagnosis.com]

  Urinary incontinence is reported in many individuals as well. To diagnose BD, a detailed patient history is the first step in the workup. The course and progression of symptoms are noted in the history. [symptoma.com]

  Symptoms include depression, muscle rigidity, difficulties walking and urinary incontinence. There is no cure for the condition. [sciencephoto.com]

• Polyuria

  Heart appeared flustered, shortness of breath, chest tightness, chest pain that involvement appears nighttime urinary frequency, polyuria, urine light show that renal involvement, renal artery hardening. [e.uuuwell.com]

• Stroke

  So, the stroke can be roughly divided into two categories, ischemic stroke and hemorrhagic stroke. 3.1 ischemic stroke ischemic stroke accounted for 60% -70% of the total number of patients with stroke, including cerebral thrombosis and cerebral embolism [e.uuuwell.com]

  The clinical picture in 11 patients was characterized by: (1) persistent hypertension and systemic vascular disease; (2) acute strokes; (3) subacute accumulation of focal neurologic symptoms and signs over weeks to months; (4) long plateau periods; (5 [ncbi.nlm.nih.gov]

  Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke. [books.google.de]

  Strokes take place when the supply of blood carrying oxygen to the brain is suddenly cut off. However, not all people with stroke will develop vascular dementia. Vascular dementia can occur over time as "silent" strokes pile up. [webmd.com]

  Patients usually show signs of abnormal blood pressure, stroke, blood abnormalities, disease of the large blood vessels in the neck, and disease of the heart valves. [ucl.ac.uk]

• Cognitive Impairment

  We also examined the indices of cognitive impairment and brain atrophy. In each group, the ventricular area-cranial space area ratio was measured by an image analyzer. [ncbi.nlm.nih.gov]

  VCI, vascular cognitive impairment, not yet dementia. [academic.oup.com]

  Hypertension, being the principal risk factor, is universally present, and a variable degree of cognitive impairment, gait disturbances and other neurological deficits are encountered in patients. [symptoma.com]

  These structural changes may be the core neurobiological mechanisms of the cognitive impairments in AD and BD. [journals.plos.org]

• Seizure

  Abnormal electrical disturbances in the brain may cause seizures. Binswanger's symptoms may be elusive in both appearance and degree. [encyclopedia.com]

  Seizures may also be present. [ucl.ac.uk]

  […] dementia and was first described in 1894.The illness occurs mainly in middle-aged hypertensive patients who show evidence of systematic vascular disease and who develop insidious fluctuating dementia with special involvement of memory, mood and cognition; seizures [alzheimer-europe.org]

  Seizures may also occur. [findmeacure.com]

  Fully developed epileptic seizures can even occur during the disease. [www2.psykl.med.tum.de]

• Apathy

  Patients with this disease usually present with apathy, agitation, and bilateral corticospinal or bulbar signs Tags: binswanger', s-disease, subcortical-dementia, white-matter-atrophy 1000 chars left No comments found. [medicalvideos.com]

  Other symptoms include forgetfulness (but not as severe as the forgetfulness of Alzheimer's disease), changes in speech, an unsteady gait, clumsiness or frequent falls, changes in personality or mood (most likely in the form of apathy, irritability, and [ninds.nih.gov]

  Synonyms Subacute arteriosclerotic encephalopathy Symptoms and course forgetfulness disorientation slowness of thought apathy lack of emotion depression aggression mild intellectual impairment (difficulties to think or reason) language difficulties problems [alzheimer-europe.org]

  The condition can be alleviated, and repeated exacerbations. 2. mainly clinical slowly progressive dementia, memory, cognitive dysfunction, emotional, and personality changes, apathy, delusions, the mildly neurotic disorders. 3. recurrent focal symptoms [e.uuuwell.com]

  Other symptoms include: forgetfulness (but not as severe as the forgetfulness of Alzheimer's disease), changes in speech, an unsteady gait, clumsiness or frequent falls, changes in personality or mood (most likely in the form of apathy, irritability, [braindiseases.blogspot.com]

• Agitation

  Patients with this disease usually present with apathy, agitation, and bilateral corticospinal or bulbar signs Tags: binswanger', s-disease, subcortical-dementia, white-matter-atrophy 1000 chars left No comments found. [medicalvideos.com]

  Atypical antipsychotic drugs, such as risperidone and olanzapine, can be useful in individuals with agitation and disruptive behavior. [ninds.nih.gov]

  Anti-psychotic drugs are often administered for individuals experiencing high agitation levels or disruptive behaviors. The drug memantine has been shown to stabilize functioning. [theadvocate.com]

  The people with depression require antidepressant medication because it consist of serotonin-specific reuptake inhibitors (SSRI) sertraline The drugs antipsychotic like risperidone and olanzapine can be helpful with agitation and disruptive behavior. [depression-guide.com]

To diagnose BD, a detailed patient history is the first step in the workup. The course and progression of symptoms are noted in the history. If patients give unreliable data regarding their illness, a heterogeneous anamnesis from either family members of close friends can be highly useful in obtaining an objective view about the condition of the patient. History of cardiovascular disease and the presence of additional risk factors and comorbidities is integral in order to make a presumptive diagnosis. The second step is a meticulous physical examination, with an emphasis on cognitive assessment and neurological examination, both equally important procedures when there is a clinical suspicion of any type of dementia. The Montreal Cognitive Assessment (MOCA), preferred over the mini-mental status examination (MMSE) is recommended for evaluation of cognitive function [1] [7]. Once valid clinical criteria for dementia are noted, the diagnosis of BD can be confirmed with imaging studies, especially magnetic resonance imaging (MRI) [1] [2] [3] [5] [7]. One of the most important features of BD on MRI are 5-10 mm lacunar infarcts, principally located in the brain stem and the majority of the white matter with signs of atrophy [1] [4]. Together with lacunar infarcts, hyperintensity of the white matter (known as leukoaraiosis), usually in the periventricular space, is diagnostic for BD [1] [4] [6]. In addition to MRI, computed tomography (CT) can also identify leukoaraiosis, and is preferred over MRI in certain circumstances [1] [4] [6].

• Foam Cell

  cells, and then death produce extracellular deposition of cholesterol in the intima and the formation of plaques. [e.uuuwell.com]

1. Huisa BN, Rosenberg GA. Binswanger’s disease: Diagnosis and Management. Expert Rev Neurother. 2014;14(10):1203-1213.
2. Huisa BN, Caprihan A, Thompson J, et al. Long-Term Blood-Brain Barrier Permeability Changes in Binswanger’s Disease. Stroke; a journal of cerebral circulation. 2015;46(9):2413-2418.
3. Kovács T, Szirmai I, Papp M. Clinico-pathology and differential diagnosis of Binswanger's disease [Article in Hungarian]. Ideggyogy Sz. 2005;58(3-4):78-87.
4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
5. Akiguchi I, Budka H, Shirakashi Y, et al. MRI features of Binswanger’s disease predict prognosis and associated pathology. Annals of Clinical and Translational Neurology. 2014;1(10):813-821.
6. Bennett DA, Wilson RS, Gilley DW, Fox JH. Clinical diagnosis of Binswanger's disease. J Neurol Neurosurg Psychiatry. 1990;53:961-965.
7. Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G. Risk factors for vascular dementia: Hypotension as a key point. Vasc Health Risk Manag. 2008;4(2):395-402.