Recently, more and more often in medical practice there are diseases caused by a violation of cerebral circulation. Basically, they appear in people who abuse alcohol and tobacco, having a history of obesity, diabetes, hypertension. One of these pathological symptom complexes is Binswanger's disease, or otherwise - subcortical atherosclerotic encephalopathy. The disease was described in 1894 and received the name of its researcher Otto Binswanger thanks to the efforts of Alois Alzheimer who proposed this idea. A more detailed study of this pathology was achieved by the Canadian neurologist Olshevsky in the middle of the twentieth century.
Definition
Binswanger's disease is a disease that is characterized by impaired subcortical cerebral circulation due to thickening of the walls of blood vessels and a decrease in their throughput. This affects the nutritional quality of the white matter of the brain. Its ischemia develops. A rapidly progressing course leads to gross neurological disorders, dementia and other complications. In addition, gait disorders, disorders of the innervation of the pelvic organs may appear. At the end of the disease, patients become completely dependent on outside help and need the services of a professional caregiver.
Etiology
Common somatic vascular pathologies, such as
hypertension, can be predisposing factors for the development of the
disease. But other conditions that cause a persistent narrowing of the small vessels of the brain can affect the development of the process. These include amyloid angiopathy and cerebral autosomal dominant angiopathy. The very concept of “Binswanger disease” should be treated with caution, since this is not a separate nosological unit, but a pathological syndrome inherent in a number of diseases, such as metachromatic leukodystrophy or progressive leukoencephalopathy.
Pathogenesis
Due to hypertension, the vessels of the brain are in a spasmodic state. Their lumen is narrowed not only due to the reduction of the smooth muscle layer, but also due to the presence of their atherosclerotic change. Thus, the nutrition of the white matter of the brain is disrupted and its ischemia occurs, and then atrophy. In places of narrowing of the arterial network, cysts, foci of hemorrhage and necrosis occur. The substance of the brain decreases in volume, becomes less dense, can be replaced by fluid or squeezed due to the compensatory expansion of the cavities of the ventricles.
Nature does not tolerate voids.
Symptoms
The disorders that Binswanger's disease causes come gradually. There are two possible options for the course of the disease:
- Continuous progradient, when there are no bright gaps and the symptoms are complicated over time.
- Slow progression with periods of plateau, when for a long time no deterioration is observed in the clinic.
As a rule, patients complain of gait disorders and urinary and fecal incontinence. They develop intellectual and emotional dementia, manifested by scanty passing neurological symptoms. There is a deterioration in memory and cognitive abilities.
On the basis of the prevailing symptomatology, specialists distinguish dysmnestic, amnestic and pseudoparalytic dementia. Criticism to their condition in patients is reduced or completely absent, the mood is usually neutral or upbeat, and forgetfulness about current events is possible. So softly and imperceptibly creeps in Binswanger's disease. The clinic can be supplemented with epileptic seizures, neurosis.
Diagnostics
When making a diagnosis, the doctor is based on the collected history, clinical picture, and laboratory and instrumental analyzes. The reason for recording in the Binswanger's disease medical card is persistent confirmed dementia, combined with any two of the signs from the list:
- gait disorders;
- pseudobulbar syndrome;
- bradykinesia;
- dysfunction of the pelvic organs;
- frontal symptoms.
In addition, the presence of hypertension, arrhythmia, myocardial infarction or diabetes mellitus is mandatory.
Differential diagnosis is performed with Alzheimer's disease using the Khachinsky ischemic scale, as well as CT and MRI data.
Treatment
In patients who are diagnosed with Binswanger's disease, treatment is carried out immediately by two doctors - a neurologist and a psychiatrist. They consult with endocrinologists, therapists, cardiologists, since therapy should cover all links of pathogenesis and stop symptoms.
An important milestone in etiopathogenetic therapy is a decrease in blood pressure to normal numbers. Of course, the existing symptoms do not regress, but this helps to prevent the deterioration. In addition, medications that improve cerebral circulation, anticoagulants to prevent the development of stroke, nootropic drugs to preserve cognitive functions are prescribed . If necessary, due to a depressed mood or the presence of mental disorders, antidepressants or antipsychotics are prescribed.
Forecast for life and health
Two weeks after the start of medication, you can see a noticeable improvement in the patient's condition. More than half of people diagnosed with Binswanger's disease have a satisfactory prognosis. However, they need to undergo a routine examination by a neurologist, therapist, psychiatrist, and cardiologist in a community clinic.
Timely diagnosis can not only extend a person’s life, but also improve its quality. For the elderly it is extremely important not to be helpless, not to become a burden for the family. They need to know what to expect from a Binswanger’s diagnosis. Disability of the II-III group is a very likely outcome of this disease. It is necessary to mentally prepare the patient for the fact that treatment only suspends the process, but does not heal and one will also have to face negative consequences, only a little later.
The Binswanger symptom complex is a common end to arterial hypertension with an atherosclerotic component. The only possible prevention of it is a diet and the right way of life at a young and mature age in order to prevent the development and progression of hypertension. Then the main etiological factor will be excluded and there will be no soil for the development of the disease.
Do not self-medicate and be healthy!