Binswanger disease is a progressive neurological disorder caused by arteriosclerosis and thromboembolism affecting the blood vessels that supply the white-matter and deep structures of the brain (basal ganglia and thalamus). Most patients experience progressive loss of memory and intellectual abilities (dementia), urinary urgency or incontinence, and an abnormally slow, shuffling, unsteady pattern of walking, usually over a 5-10 year period. Due to their vascular etiology, the symptoms and physical findings associated with Binswanger disease may suddenly worsen due to stroke, stabilize and then improve for a brief time, but the patient's overall condition continues to progress as the blood vessels become increasingly obstructed.
Affected individuals often become depressed, uncaring (apathetic), inactive, and unable to act or make decisions (abulic). They become withdrawn, and exhibit poor judgement and less spontaneous communication. In addition, affected individuals may have difficulty with speech (dysarthria), swallowing (dysphagia), and urinary bladder control (incontinence). Some patients exhibit abnormalities that are similar to those seen in Parkinson disease, such as slowness, poor balance and short, shuffling steps (parkinsonism).
Many individuals with Binswanger disease have a history of strokes or transient ischemic attacks. Consequently, the symptoms and signs of this disease develop in a stuttering or stepwise fashion, in contrast to the insidious, gradually progressive course of neurodegenerative diseases (see Related Disorders).
Binswanger disease is caused by atherosclerosis, thromboembolism and other diseases that obstruct blood vessels that supply the deep structures of the brain. Hypertension, smoking, hypercholesterolemia, heart disease and diabetes mellitus are risk factors for Binswanger disease. Rare hereditary diseases such as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) also cause Binswanger disease. Thus, Binswanger disease is actually a clinical syndrome of vascular dementia with multiple causes, not a specific disease.
Binswanger disease affects males and females in equal numbers and usually occurs in individuals age 50 years or older.
The diagnosis of Binswanger disease is usually based on a thorough clinical evaluation, a detailed patient history, identification of characteristic findings, and magnetic resonance imaging (MRI) or computerized tomography (CT) scanning of the brain. MRI and CT reveal nerve fiber (white matter) degeneration and multiple small strokes in the deep structures of the brain.
The ischemic brain damage in Binswanger disease is not reversible, so treatment is focused on reducing risk factors for stroke, thereby retarding progression of the disease. Treatment usually involves the use of anti-hypertensive drugs to control blood pressure, antiplatelet drugs (e.g., aspirin) or warfarin to reduce thromboembolism, statins to reduce atherosclerosis, smoking cessation and diabetic control. Antidepressant drugs are helpful in the management of depression associated with Binswanger disease. Other treatment is symptomatic and supportive.
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Contact for additional information about Binswanger’s disease:
Rodger J. Elble, MD, PhD
Professor and Chair of Neurology
Director, Parkinson Disease and Movement Disorders Center
Neurology Residency Director
Southern Illinois Univeristy School of Medicine
PO Box 19643
Springfield, IL 62794-9643
Phone: (217) 545-7182
FAX: (217) 545-1903
email: email@example.com or firstname.lastname@example.org
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