Atherosclerotic encephalopathy of Binswanger

Description:

Binswanger's disease is the chronic progressing brain disease developing at an idiopathic hypertensia which kliniko-morphological expression is the subcortical arteriosclerotic encephalopathy leading finally to dementia and proceeding with episodes of acute development of focal symptomatology or with the progressing neurologic frustration connected with defeat of white matter of cerebral hemispheres.
In certain cases the term "Binswanger's disease" designate subacute development of diffusion defeat of white matter of a brain with clinic by a picture of quickly progressing dementia and other manifestations of dissociation against the background of the adverse course of an arterial hypertension.
The disease (encephalopathy) of Binswanger meets quite often.

Symptoms of Atherosclerotic encephalopathy of Binswanger:

The clinical picture of a disease of Binswanger is characterized by the progressing cognitive disturbances, dysfunctions of walking and pelvic frustration. At the last stage of a disease the clinical picture is presented by weak-mindedness, full helplessness of the patient which do not go, do not service themselves, do not control function of pelvic bodies.

The weak-mindedness picture considerably varies both on severity, and on features of symptomatology. Except for asemichesky, practically the same syndromal options of dementia are observed, as at vascular weak-mindedness: dismnestichesky (torpid and all-organic options), anamnestic and pseudoparalytic. At the same time the expressed phenomena of an aspontannost, euphoria are frequent in a varying degree. At the same time the neuropsychological analysis of dementia indicates domination of the symptoms of subcrustal and frontal dysfunction presented in various proportions: at more slight dementia symptoms of subcrustal dysfunction prevail, at heavier - frontal (Medvedev A. V., Korsakova N. K., etc., 1996). Also cases with epileptic seizures are described (Babikian V., Popper A., 1987). In general the steady and progreduated current is characteristic of a disease (encephalopathy) of Binswanger, but also the periods of long stabilization are possible. The weak-mindedness reasons in these cases existence of "disconnection-syndrome" is considered (Roman G., 1987), that is the dissociation of corticosubcortical bonds which is caused defeat of subcrustal white matter and also dysfunction basal ганглиев and a thalamus.

Change of gait at initial stages of a disease of Binswanger consist in the following: the gait shuffling or tripping, with small steps, "magnetic" (legs as if stick to a floor). At the following stage it becomes "careful", the basic area of standing increases, automatism of walking (a dyspraxia or apraxia of walking) breaks up and more and more any control of walking joins – gait of such patient reminds gait of the healthy person who appeared on the ice-rink.

The main characteristics of a frontal dyspraxia of the walking connected from dezavtomatizatsiy walking, the following:
• walking delay;
• shortening of a step;
• difficulty at the beginning of walking (walking initiation);
• instability at turns (postural dysfunction);
• expansion of base of a support;
• decrease in length of steps.

Development of "hyperactivity" ("giperreflektornost") of a bladder is characteristic of disturbance of pelvic functions at Binswanger's disease that is shown by the increased sokratitelny activity of a detruzor. The hyperactivity of a bladder is characterized: the speeded-up urination; imperative desires on an urination which in process of progressing of a disease pass into cases of an imperative incontience of urine.

Motive disturbances can be also characterized (in addition to walking disturbance): other extrapyramidal pathology in the form of parkinsonopodobny symptomatology, and also easy or moderate central mono - or the hemiparesis which is often quickly regressing (regress of focal motive symptomatology becomes incomplete in process of progressing of a disease). The pseudobulbar syndrome is characteristic.

Emotional and strong-willed disturbances are presented asthenic, neurosis-like or astheno-depressive a syndrome. In process of progressing of a disease to the forefront there are not an adynamy and a depression, and increase of emotional impoverishment, narrowing of a focus of interest and spontaneity.

Reasons of Atherosclerotic encephalopathy of Binswanger:

Etiology. Risk factors of a course of a disease (encephalopathy) of Binswanger is, first of all, persistent arterial hypertension which is noted at 75-90% of patients with this pathology. Faces of senile age such factor can have also an arterial hypotension, as well as disturbance of a circadian rhythm of arterial pressure (increase or a sharp lowering of arterial pressure at night) in the absence of changes from the main arteries of the head. Also family cases from the beginning to 40 years, without arterial hypertension are described. More than in 80% of cases the disease debuts in an age interval from 50 to 70 years.

Also etiological the amyloid angiopatiya and a hereditary disease of CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (a cerebral autosomal and dominant angiopatiya with subcortical heart attacks and a leukoencephalopathy) which unlike the majority of cases of SAE arises at rather young age can be the cornerstone of a course of a disease of Binswanger.

Treatment of Atherosclerotic encephalopathy of Binswanger:

Treatment of a disease of Binswanger has to include the influences directed to a basic disease against the background of which it develops - an arterial hypertension, etc. (etiopatogenetichesky therapy), improvements of cerebral circulation, metabolic processes (pathogenetic therapy), elimination of neurologic and psychopathological syndromes (symptomatic therapy). Considering that the most part of patients with Binswanger's disease is in advanced and senile age, it is necessary to carry out adequate therapy of the accompanying somatopathies which current on physiogene or psychogenic mechanisms has significant effect on the psychological status of patients. Treatment of atherosclerosis, arterial hypertension, the accompanying somatopathies has to be carried out together with the corresponding specialists.