An elderly man with a long-standing history of dementia presented with acute-onset altered mental status. Unenhanced computed tomography (A) demonstrated extensive, confluent regions of subcortical and deep white mater hypoattenuation, consistent with sequelae of microvascular ischemic disease. Axial T2 (B) and fluid attenuated inversion recovery (FLAIR, C) images showed multiple areas of abnormal hyperintense signal intensity involving the periventricular white matter and corona radiata, as well as “studding” of the basal ganglia and thalami. An axial gradient echo (GRE, D) image revealed scattered foci of microhemorrhage. These imaging findings in the clinical setting of dementia with acute or subacute neurological dysfunction are suggestive of Binswanger disease.
Also called subcortical vascular dementia, Binswanger disease results from repeated hypoxic-ischemic events involving the arterioles supplying the deep white matter.1 There is often widespread loss of myelin, particularly in the periventricular regions, corona radiata, and centrum semiovale. Lacunar infarcts are also common in the deep gray and white matter, pons, and occasionally in the cerebellum. Clinical presentation overlaps with other types of dementia and often features cognitive deficits, motor and/or sensory deficits, and behavioral changes.1 The degree of subcortical white matter disease, cerebral hypoperfusion, and cerebral atrophy have been shown to correlate with the extent of motor and cognitive dysfunction.2
At the Viewbox: Binswanger Disease. J Am Osteopath Coll Radiol.