Binswanger disease (subcortical arterioslcerotic encephalopathy)
Dementia, impaired intellectual function, chronic hypertension.
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Extensive patchy confluent symmetric changes in bilateral cerebral periventricular and deep white matter, bilateral basal ganglia, thalami and pons noted that appear hyperintense on T2W, FLAIR images, hypointense on T1 images.
Small gliotic foci/ chronic lacunes in bilateral corona radiata, basal ganglia and thalami, that show CSF signals with peripheral FLAIR hyperintensity.
No remarkable acute infarct/ restricted diffusion.
Subtle microbleed in pons on left side on GRE images.
There is relative sparing of the subcortical U-fibers and the corpus callosum. Ventricular system, cisternal spaces and sulcal spaces appear prominent suggesting mild cerebral atrophy is seen.
Bilateral extensive white matter changes (a.k.a. leukoaraiosis) are seen in various conditions:
- Binswanger disease
- Alzheimer's disease
- multiple sclerosis (MS)
- progressive multifocal leukoencephalopathy (PML)
- normal elderly individuals
Clinical presentation of the patient, including age, presence or absence of hypertension usually helps in differentiating most of these causes.
- Senile Dementia of the Binswanger's Type: CYNTHIA G. OLSEN, MARK E. CLASEN et al, Am Fam Physician. 1998 Dec 1;58(9):2068-2074. http://www.aafp.org/afp/1998/1201/p2068.html