Binswanger's disease – subkortikalny encephalopathy, the progressing defeat of white substance of a brain. It is in most cases caused by an arterial hypertension, it is less often provoked by an amyloid angiopatiya and genetically caused angiopatiy CADASIL. It is shown by disorders of thinking and cognitive activity, the progressing weak-mindedness, violations of walking and disorders of functions of pelvic bodies. At late stages patients are completely helpless and need permanent care. Treatment – symptomatic and pathogenetic therapy of the main disease, correction of neurologic and mental violations.
Binswanger's disease – the progressing subkortikalny encephalopathy. It is caused by vascular disorders as a result of permanent increase in arterial pressure. It was for the first time described in 1894 by the German neuropathologist and the psychiatrist Otto Binswanger. Became widely known, thanks to Binswanger Alzheimer's pupil. For a long time did not admit most of neuropathologists and psychiatrists because of insufficiently accurate description and the small number of the studied cases.
The relation to Binswanger's disease changed after emergence of MPT and KT of a brain. The data obtained when carrying out a computer tomography and magnetic and resonant tomography confirmed the general nature of changes of white substance of a brain at patients with an arterial hypertension with the accompanying progressing dementia. Now the disease is considered rather widespread, the set of publications is devoted to researches of a disease of Binswanger. Treatment of a disease of Binswanger is performed by neuropathologists and experts in the field of psychiatry.
Etiology and pathogenesis of a disease of Binswanger
Permanent increase in arterial pressure is the main reason for development of this disease at an essentsialny or symptomatic hypertension. Experts note that at elderly people the disease can be provoked by continuous decrease or sharp daily fluctuations of arterial pressure. In literature mentions of patients at which subcrustal encephalopathy arose against the background of normal arterial pressure meet. In some cases other diseases which are followed by defeat of vessels of a brain (an amyloid angiopatiya and a cerebral autosomno-prepotent angiopatiya) become a starting factor.
According to various data, patients with arterial hypertension make from 75 to 98% of total of patients with Binswanger's disease. At a symptomatic and essentsialny hypertension the first symptoms of subcrustal encephalopathy usually are found at the age of 50 years and are more senior, average age of patients makes 54-66 years. At the patients suffering from genetically caused angiopatiya, symptoms of the progressing dementia appear on average or young age. The amyloid angiopatiya is usually diagnosed for elderly people.
Pathological changes of white substance are caused by the sclerosis of small arteries of a brain which is followed by reduction of a gleam of vessels and increase in thickness of a vascular wall. Total deterioration in blood supply of subcrustal areas causes diffusion changes of white substance of atrophic character. In white substance there are multiple hemorrhages, cysts and the small centers of destruction, its density decreases, it decreases in volume and is partially replaced with liquid (hydrocephaly). Ventricles of a brain extend.
Symptoms of a disease of Binswanger
Violations of gait, disorder of function of pelvic bodies, unsharply or moderately expressed neurologic symptoms (usually passing), progressing weak-mindednesses, strong-willed and emotional violations are characteristic of vascular subcrustal encephalopathy. The disease develops gradually. Perhaps both a continuous progrediyentny current, and slow progressing with the long periods of stabilization. Aggravation of symptomatology usually is directly connected with long increase in arterial pressure. Full helplessness, inability to self-service and lack of control over functions of pelvic bodies becomes an outcome.
Weak-mindedness has the character typical for vascular diseases of a brain. The memory impairment, decrease in level of judgments, delay and instability of mental processes is observed. Often "the emotional incontience" - the expressed inability to constrain emotions with prevalence of asthenic reactions comes to light. The long periods of stabilization and even temporary regress of the available violations are possible.
Depending on the prevailing symptomatology allocate dismnestichesky, amnestichesky and pseudo-paralytic weak-mindedness. At dismnestichesky weak-mindedness unsharply expressed decrease in memory and intelligence, delay of physical and mental reactions is observed. The criticism to own state and behavior is slightly broken. In a clinical picture of amnestichesky weak-mindedness the expressed violations of memory on the current events at preservation of last memoirs prevail. The steady, monotonous complacent mood, insignificant disorders of memory and the expressed decrease in criticism are characteristic of pseudo-paralytic weak-mindedness.
The clinical picture at all forms of weak-mindedness is very variable, prevalence of both cortical, and subcrustal violations can come to light, at the same time cortical violations are followed by more noticeable decrease intellectual activity. Epileptic seizures are in some cases observed. Weak-mindedness is followed by violations in the emotional and strong-willed sphere. The nevrozopodobny phenomena, the raised exhaustion and decrease in mood are possible. At late stages of a disease restriction of interests, emotional impoverishment and loss of spontaneity is noted.
Gait violations, as well as weak-mindedness, progress gradually. In the beginning steps become smaller, the patient begins to shuffle the feet, hard tears off legs from the earth. In the subsequent automatism of walking is broken, gait becomes slow and careful, all movements are controlled consciously as though the patient goes on slippery ice. Allocate the following signs of violations of gait at Binswanger's disease: reduction of length of a step, walking delay, the need for the increased stability, difficulties at the beginning of walking and decrease in stability at turns.
Violations of functions of pelvic bodies at initial stages are shown by a bladder hyperactivity – sudden strong desires on an urination and increase of an urination which when progressing a disease are transformed to an imperative incontience of urine. Along with violations function of pelvic bodies also other neurologic symptoms can come to light, including – a psevdobulbarny syndrome, passing paresis and parkinsonopodobny frustration.
Diagnosis of a disease of Binswanger
The diagnosis is exposed on the basis of the anamnesis, a clinical picture, data of KT and MPT of a brain. The basis for diagnosis is clinically significant dementia confirmed with results of a neuropsychological research in combination with at least two signs characteristic of Binswanger's disease. Among these signs – existence of the disease which is followed by system defeat of vessels (a symptomatic or essentsialny hypertension, arrhythmia, a myocardial infarction, diabetes etc.); neurologic violations (disorders of walking, a spastic bladder, imperative desires on an urination or an imperative incontience of urine); certificates of vascular pathology of a brain (a stroke in the anamnesis, focal neurologic symptoms).
In certain cases Binswanger's disease is required to be differentiated with Alzheimer's disease. In the course of differential diagnostics use the ischemic scale of Hachinsky considering gradualness or a sudden onset of the illness, a progrediyentnost or a stupeneobraznost of a current, expressiveness of violations of the personality, and also existence or lack of depressive frustration, emotional instability, an arterial hypertension, atherosclerosis, strokes and neurologic frustration.
Treatment of a disease of Binswanger
Treatment is performed by neurologists and psychiatrists in cooperation with therapists, cardiologists, endocrinologists and other experts (depending on the main pathology). The plan of treatment is made individually, taking into account a stage and features of a course of the main disease, expressiveness of neurologic, mnestichesky, emotional and intellectual violations. Carry out etiopatogenetichesky and symptomatic therapy, appoint medicines for correction of an emotional state and improvement of cognitive functions. Increase HELL therefore its normalization becomes an important problem of therapy is the cornerstone of a disease. At the same time it is necessary not to allow an excessive lowering of arterial pressure, constantly supporting indicators within 120/80 mm of mercury., as hypotonia can promote aggravation of the arisen violations.
For prevention of violations of brain blood circulation appoint antitrombotsitarny means. In the presence of the accompanying heart troubles use anticoagulants. Apply MAO inhibitors, nootropa, antioxidants, neurotrophic, membrane stabilizing and antikholinesterazny medicines to improvement of cognitive functions. At depressive frustration perform therapy with use of antidepressants (mainly – inhibitors of the return capture of serotonin).