Binswanger disease (subcortical arterioslcerotic encephalopathy)

Case contributed by Dr Jignesh Modi


Dementia, impaired intellectual function, chronic hypertension.

Patient Data

Age: 50
Gender: Female

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.

Case Discussion

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.

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Case information

rID: 32829
Published: 18th Dec 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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