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Computed tomography, magnetic resonance imaging and pathological correlations in a case of Binswanger's disease
M Mascalchi1, D Inzitari, G Dal Pozzo
1Department of Neurology, University of Florence, Italy.
Insights
This study details Binswanger's disease (BD), a white matter degeneration causing vascular dementia in hypertensive patients. Imaging aids diagnosis, but pathological confirmation is essential for conclusive findings.
Area of Science:
- Neurology
- Pathology
- Radiology
Background:
- Binswanger's disease (BD) is a form of arteriosclerotic dementia characterized by white matter degeneration.
- Hypertension is a significant risk factor associated with the development of BD.
Observation:
- Computed tomography (CT) and magnetic resonance (MR) imaging over seven years revealed white matter disease in a hypertensive patient.
- Post-mortem MR and histopathology confirmed white matter degeneration sparing U fibers as the primary cause of dementia.
Findings:
- Histopathology showed rarefaction of myelin sheaths and axons, alongside severe thickening of medullary arteries.
- These pathological findings support BD as a distinct subtype of arteriosclerotic dementia.
Implications:
- CT and MR imaging are valuable diagnostic tools for suspected Binswanger's disease.
- Differential diagnosis is crucial, as other conditions can mimic BD on imaging, necessitating pathological confirmation for definitive diagnosis.
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.