Laboratory Diagnosis in Neurology, 1 Ed.

Subcortical Arteriosclerotic Encephalopathy

M. Otto

Clinical Features

The clinical picture of subcortical arteriosclerotic encephalopathy (SAE, Binswanger's disease) corresponds to that of subcortical dementia, with exhaustion, attention disorder, apathy, and psychomotor slowness (Holmes et al., 1999). The patients are often emotionally unstable, and usually exhibit irritability. Neurological symptoms that may occur include urinary incontinence, vertigo, and transitory ischemic attacks as well as focal neurological signs. Essential hypertension predisposes to SAE.

Diagnosis

Neuroimaging. A suspected diagnosis of SAE can be confirmed by brain CT or MRI. Spotted or diffuse lesions are usually present in the periventricular regions.

CSF analysis. The CSF levels of tau protein may be anywhere between normal and, occasionally, highly pathological.

Neuropathology. Neuropathological findings include spotted and diffuse ischemic lesions in the white matter, demyelination by hyaline degeneration, and fibrotic wall thickening of the long, perforated arteries in the white matter.

References

Holmes C, Cairns N, Lantos P, Mann A. Validity of current clinical criteria for Alzheimer's disease, vascular dementia and dementia with Lewy bodies. Br J Psychiatry 1999;174:45–50

Further Reading

Hüll H, Bauer J. Demenzen. In: Berlit P, ed. Klinische Neurologie. Heidelberg: Springer; 1999:829–856

Kretzschmar HA, Neumann M. Neuropathological diagnosis of neurodegenerative and dementia diseases. Pathologe 2000;21:364–374