Vascular glycosaminoglycans in periventricular leukoencephalopathy

Three cases of adult dementia with periventricular leukoencephalopathy demonstrated staining with alcian blue dye (alcianophilia) in thickened cerebral arteries and arterioles of the abnormal white matter. The property of alcianophilia identifies glycosaminoglycans (GAGs); retention of alcian blue staining at high MgCl2 concentrations (0.7 M) in these cases indicates that the GAGs are highly sulfated and are likely to represent heparan sulfate. Arteriosclerotic risk factors (including hypertension) were absent in all cases, suggesting that GAG deposition occurred as part of a separate cerebral vasculopathic process. These findings suggest that cerebral white matter changes associated with dementia do not always represent Binswanger's disease.