Computed Tomography, Magnetic Resonance Imaging and Pathological Correlations in a Case of Binswanger's Disease

Abstract

The results of 3 computed tomography (CT) examinations carried out over a 7 year period and of a post-mortem magnetic resonance (MR) study showed aspects of a white matter disease in a hypertensive patient suffering from vascular dementia. Histopathology revealed the primary cause of dementia to be a white matter degeneration sparing the U fibers. Rarefaction of both the myelin sheaths and the axons was present together with severe thickening of the medullary arteries. These findings support the existence of Binswanger's disease (BD) as a distinct variety of arteriosclerotic dementia. CT and MR imaging are valuable aids for diagnosis. However, since there are many other causes of CT and MR demonstrated diffuse white matter degeneration in the elderly, a conclusive diagnosis of BD requires pathological confirmation. RESUME: Tomodensitometrie, imagerie par resonance magnetique nucleaire et correlations anatomopathologiques dans un cas de maladie de Binswanger Trois tomodensitometries faites sur une periode de sept ans et un examen par resonance magnetique nucleaire effectue en post-mortem ont mis en evidence des modifications compatibles avec une leuco-encephalopathie chez un patient hypertendu atteint d'une demence vasculaire. L'histopathologie a montre que la cause primaire de la demence etait une degSnerescence de la substance blanche epargnant les fibres en U. II existait une rarefaction des gaines de myeline et des axones ainsi qu'un epaississement important des arteres medullaires. Ces observations supportent la notion que la maladie de Binswanger (MB) est une variete distincte de d6mence arteriosclereuse. La tomodensitometrie et 1'imagerie par resonance magnetique nucleaire sont des aides precieuses pour le diagnostic. Cependant, comme il existe plusieurs autres causes de degenerescence de la substance blanche chez les sujets ages, qui sont evidentes a la tomodensitometrie et a l'imagerie par resonance magnetique nucleaire, une confirmation anatomopathologique du diagnostique de MB est essentielle.

The burden of microstructural damage modulates cortical activation in elderly subjects with MCI and leuko‐araiosis. A DTI and fMRI study

“…Moreover, patients with agenesis of the corpus callosum do not show any overactivations in the hemisphere ipsilateral to a moved hand consistent with the hypothesis that loss of callosal afferents would lead to decreased ipsilateral sensorimotor activation [Reddy et al, ]. On the contrary, intriguingly, U fibers such those documented by Catani et al [ ] were shown to be substantially unaffected in our TBSS analysis and are typically spared in pathological cases of severe LA featuring pathological description of subcortical arteriosclerotic encephalopathy [Mascalchi et al, ] (Fig. ).…”

“…TBSS revealed that, with increasing extension of LA on visual assessment, a substantially symmetric damage of the long WM tracts in terms of increased MD and decreased FA emerged. It is noteworthy that the distribution of this tract damage matched that of the WM damage reported in pathological cases of extreme LA featuring subcortical arteriosclerotic encephalopathy or Binswanger's disease [Mascalchi et al, 1989] as exemplified in Figure 1. This uncommon condition is in fact characterized by symmetric involvement of the long WM tracts of the cerebral hemispheres and by relative sparing of both the U fibers and of the WM of the brainstem and cerebellum.…”

Leukoaraiosis: A reappraisal. II. MRI studies

“…On the other hand, pre-and post-mortem MRI in patients with clinical diagnosis of Binswanger encephalopathy [14,34,42,45] have revealed that the MRI signal of the diffuse white matter changes associated to this condition behaves quite like that of LA. On the other hand, pre-and post-mortem MRI in patients with clinical diagnosis of Binswanger encephalopathy [14,34,42,45] have revealed that the MRI signal of the diffuse white matter changes associated to this condition behaves quite like that of LA.…”