Recently, more and more often in medical practice there are diseases caused by impaired cerebral circulation. They are mainly manifested in people who abuse alcohol and tobacco, have 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 made by the Canadian neurologist Olshevsky in the middle of the twentieth century.
Definition
Binswanger's disease is a disease that is characterized by a violation of the subcortical cerebral circulation due to thickening of the walls of blood vessels and a decrease in their throughput. This affects the quality of nutrition of the white matter of the brain. Ischemia develops. A rapidly progressive course leads to severe neurological disorders, dementia and other complications. In addition, gait disturbances, disorders of the innervation of the pelvic organs may appear. At the end of the illness, patientsbecome completely dependent on outside help and need the services of a professional carer.
Etiology
Predisposing factors for the development of the disease may be general somatic vascular pathologies, such as hypertension. But other conditions that cause 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's 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 atherosclerotic changes. Thus, the nutrition of the white matter of the brain is disturbed and its ischemia occurs, and then atrophy. In places of narrowing of the arterial network, cysts, foci of hemorrhage and necrosis appear. The substance of the brain decreases in volume, becomes less dense, may be replaced by fluid or compressed due to compensatory expansion of the cavities of the ventricles. Nature abhors emptiness.
Symptoms
The disturbances that Binswanger's disease causes are cominggradually. There are two options for the course of the disease:
- Continuous progradient, when there are no light gaps and the symptoms become more complicated over time.
- Slow progression with periods of plateau, when no deterioration in the clinic is observed for a long time.
As a rule, patients complain of gait disturbances and urinary and fecal incontinence. They develop intellectual and emotional dementia, manifested by scanty transient neurological symptoms. There is deterioration in memory and cognitive abilities.
Based on the prevailing symptoms, experts distinguish dysmnestic, amnestic and pseudo-paralytic dementia. Criticism of their condition in patients is reduced or absent altogether, the mood is usually neutral or upbeat, forgetfulness of current events is possible. This is how Binswanger's disease creeps up gently and imperceptibly. The clinic can be supplemented by epileptic seizures, neurosis.
Diagnosis
When making a diagnosis, the doctor is based on the collected history, clinical picture and laboratory and instrumental tests. The basis for the entry in the medical card "Binswanger's disease" is persistent confirmed dementia, combined with any two signs from the list:
- gait disturbances;
- pseudobulbar syndrome;
- bradykinesia;
- dysfunction of the pelvic organs;- frontal symptoms.
In addition, the presence of hypertension, arrhythmias, myocardial infarction or diabetes is mandatory.diabetes.
Differential diagnosis is carried out with Alzheimer's disease using the Khachinsky ischemic scale, as well as CT and MRI data.
Treatment
In patients diagnosed with Binswanger's disease, treatment is carried out by two doctors at once - a neurologist and a psychiatrist. They consult with endocrinologists, internists, cardiologists, since therapy should cover all links of pathogenesis and stop symptoms.
An important milestone in etiopathogenetic therapy is the reduction of blood pressure to normal levels. Of course, the existing symptoms do not regress, but this helps to prevent deterioration. In addition, drugs are prescribed that improve cerebral circulation, anticoagulants to prevent the development of stroke, nootropic drugs to preserve cognitive functions. If necessary, due to depressed mood or the presence of mental abnormalities, antidepressants or antipsychotics are prescribed.
Prognosis for life and he alth
Two weeks after the start of medication, a noticeable improvement in the patient's condition can be seen. More than half of people diagnosed with Binswanger's disease have a satisfactory prognosis. However, they need to undergo a routine examination by a neuropathologist, internist, psychiatrist and cardiologist at a polyclinic at their place of residence.
Timely diagnosis can not only prolong a person's life, but also improve its quality. For the elderly, it is essenti alto be helpless, not to turn into a burden for the family. They need to know what to expect from a diagnosis of Binswanger's disease. Group II-III disability is a very likely outcome of this disease. It is necessary to mentally prepare the patient for the fact that the treatment only stops the process, but does not heal, and negative consequences will also have to be faced, only a little later.
Binswanger's symptom complex is a common ending of arterial hypertension with an atherosclerotic component. The only possible prevention of it is a diet and a proper lifestyle 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 ground for the development of the disease.
Don't self-medicate and stay he althy!
