Predominant white matter involvement in subcortical arteriosclerotic encephalopathy (Binswanger disease)

Fifteen of 605 examinations of patients aged 60 to 85 years showed symmetrical white matter hypodensity on computed tomography (CT). Six of these showed severe white matter hypodensity, low grade atrophy, and dilated ventricles. A diagnosis of encephalopathia subcorticalis chronica progressiva, or Binswanger disease, featuring the typical clinical course of neurological and psychiatric symptoms was reached. In one case, the diagnosis was confirmed by postmortem anatomopathological findings. The etiology is considered to be vascular and to represent a special course of arteriosclerosis. In some elderly patients, both white and gray matter involvement is seen on CT, but white matter hypodensity is not a common finding in severe vascular brain atrophy.