Binswanger disease: symptoms and treatment

Recently, more often in medical practice, there are diseases caused by a violation of cerebral circulation. They are mainly manifested in people who abuse alcohol and tobacco, have a history of obesity, diabetes, hypertension. One of such pathological symptom complexes is Binswanger's disease, or else - subcortical atherosclerotic encephalopathy. The disease was described in 1894 and received the name of its researcher Otto Binswanger due to the efforts of Alois Alzheimer, who proposed this idea. A more detailed study of this pathology was made possible by the Canadian neurologist Olszewski in the middle of the twentieth century.

Definition of

Binswanger's disease is a disease characterized by impaired subcortical cerebral circulation by thickening the walls of blood vessels and reducing their flow capacity. This affects the quality of nutrition of the white matter of the brain. Ischemia develops. A rapidly progressing course leads to gross neurologic disorders, dementia and other complications. In addition, gait disturbances, disorders of innervation of the pelvic organs may appear. In the final illness, patients become completely dependent on outside help and need the services of a professional nurse.

Etiology

Predisposing factors for the development of the disease may be common somatic vascular pathologies, such as hypertension. 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 of

Because of hypertension, cerebral vessels are in a spasmodic state. Their lumen is narrowed not only by reducing the smooth muscle layer, but also due to the presence of atherosclerotic changes. Thus, the white matter of the brain is disturbed and its ischemia arises, and then atrophy. Cysts, foci of hemorrhage and necrosis occur in the arterial network narrowing. The substance of the brain decreases in volume, becomes less dense, can be replaced by a liquid or squeezed due to compensatory expansion of the cavities of the ventricles. Nature does not tolerate emptiness.

Symptoms of

The disorders that cause Binswanger's disease come gradually. There are probably two variants of the course of the disease:

1. Continuous progradient, when there are no bright gaps and the symptomatology becomes more complicated with time.
2. Slow progression with plateau periods, when there is no deterioration in the clinic for a long time.

As a rule, patients complain of gait disturbances and incontinence of urine and feces. They develop intellectual and emotional dementia, manifested by scanty passing neurological symptoms. There is a deterioration in memory and cognitive abilities.

Based on the prevailing symptoms, specialists identify dysmnestic, amnestic and pseudoparalytic dementia. Criticism to their condition in patients is reduced or absent altogether, the mood is usually neutral or upbeat, forgetting for current events is possible. So gently and imperceptibly sneaks up Binswanger's disease. The clinic can be supplemented by epileptic seizures, neuroses.

Diagnosis

When diagnosing a physician based on the collected history, clinical picture and laboratory and instrumental analyzes performed. The basis for recording in the medical card "Binswanger's disease" is persistent confirmed dementia, combined with any two of the signs from the list:

- gait disturbances;
- pseudobulbar syndrome;
- bradykinesia;
- dysfunction of the pelvic organs;
- frontal symptoms.

In addition, necessarily the presence of hypertension, arrhythmia, myocardial infarction or diabetes.

Differential diagnosis is performed with Alzheimer's disease using the ischemic Khachinsky scale, as well as CT and MRI data.

Treatment of

Patients diagnosed with Binswanger's disease are treated by two doctors, a neurologist and a psychiatrist. They consult with endocrinologists, therapists, cardiologists, since the therapy should cover all links of pathogenesis and stop the symptoms.

An important milestone in etiopathogenetic therapy is the reduction in blood pressure to normal numbers. Of course, the existing symptomatology does not regress, but it helps to prevent deterioration. In addition, drugs that improve cerebral circulation, anticoagulants are prescribed to prevent the development of stroke, nootropic drugs for the preservation of cognitive functions. If necessary, due to depressed mood or the presence of mental abnormalities, prescribe antidepressants or antipsychotics.

Prognosis for life and health

Two weeks after the start of taking medication, you can see a marked 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 from a neurologist, a therapist, a psychiatrist and a cardiologist in a polyclinic at the place of residence.

Timely diagnosis can not only prolong 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 the diagnosis of "Binswanger's disease."Disability II-III group - this is a very likely outcome of this disease. We need to mentally prepare the patient for the fact that the treatment only pauses the process, but does not heal and will have to face negative consequences only a little later.

The Binswanger Symptom Complex is a common end of arterial hypertension with an atherosclerotic component. The only possible prevention of it is a diet and the right way of life in young and adulthood, to prevent the development and progression of hypertension. Then the main etiologic factor will be excluded and there will be no soil for the development of the disease.

Do not self-medicate and stay healthy!