(Stroke. 1995;26:1293-1301.)
© 1995 American Heart Association, Inc.
Articles |
The Significance of Cerebral White Matter Abnormalities 100 Years After Binswanger's Report
A Review
From the Department of Pathology (Neuropathology), Henry Ford Hospital, Detroit, Mich (L.P., J.H.G.); the Department of Pathology (Neuropathology), Case Western Reserve University, Cleveland, Ohio (J.H.G.); and the Department of Neurological and Psychiatric Sciences, University of Florence (Italy) (L.P.).
Correspondence to Julio H. Garcia, MD, Department of Pathology (Neuropathology), Henry Ford Hospital, K-6, 2799 W Grand Blvd, Detroit, MI 48202-2689.
Background Changes in the cerebral hemispheric white matter are detected with increasing frequency by CT and MRI among persons older than 60 years. The pathogenesis, clinical significance, and morphological substrate of these changes are incompletely understood. Patients who have such neuroimaging abnormalities are sometimes diagnosed with "Binswanger's disease," an eponym that has generated much confusion because of its imprecise meaning. The objectives of this study were to determine whether the term Binswanger's disease merits acceptance as a distinct clinicopathologic entity, to deduce the clinical significance of these white matter abnormalities from the analysis of appropriate publications, and to evaluate studies that correlate in vivo changes in the cerebral white matter with pathological features.
Summary of Review We evaluated Binswanger's original case description and, after conducting a Medline search, reviewed more than 160 publications, mostly in the English language, on the subject of white matter abnormalities detectable by currently used neuroimaging methods (ie, leukoaraiosis).
Conclusions Binswanger's original description appears to be insufficient for the purpose of defining a new nosological entity. After evaluating the vaguely outlined pathological correlates described in a few of these subcortical cerebral leukoencephalopathies, we conclude that the clinical significance of leukoaraiosis remains incompletely defined. However, its frequency increases with age independent of other risk factors, and in nondemented subjects leukoaraiosis is associated with deficits in selected cognitive functions. Moreover, leukoaraiosis correlates with an increased risk for the subsequent development of strokes. We make specific suggestions for future studies that may help to clarify this topic.
Key Words: leukoencephalopathy • small-vessel disease • leukoaraiosis • dementia
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R. Mantyla, T. Erkinjuntti, O. Salonen, H. J. Aronen, T. Peltonen, T. Pohjasvaara, and C.-G. Standertskjold-Nordenstam Variable Agreement Between Visual Rating Scales for White Matter Hyperintensities on MRI : Comparison of 13 Rating Scales in a Poststroke Cohort Stroke, August 1, 1997; 28(8): 1614 - 1623. [Abstract] [Full Text]
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V. I. H. Kwa, J. Stam, L. M. Blok, B. Verbeeten Jr, and f. t. A. V. M. Group T2-Weighted Hyperintense MRI Lesions in the Pons in Patients With Atherosclerosis Stroke, July 1, 1997; 28(7): 1357 - 1360. [Abstract] [Full Text]
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R. Schmidt, H. Schmidt, F. Fazekas, M. Schumacher, K. Niederkorn, P. Kapeller, V. Weinrauch, and G. M. Kostner Apolipoprotein E Polymorphism and Silent Microangiopathy-Related Cerebral Damage : Results of the Austrian Stroke Prevention Study Stroke, May 1, 1997; 28(5): 951 - 956. [Abstract] [Full Text]
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L. Pantoni and J. H. Garcia Pathogenesis of Leukoaraiosis : A Review Stroke, March 1, 1997; 28(3): 652 - 659. [Abstract] [Full Text]
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L. Pantoni, J. H. Garcia, J. A. Gutierrez, and W. I. Rosenblum Cerebral White Matter Is Highly Vulnerable to Ischemia Stroke, September 1, 1996; 27(9): 1641 - 1647. [Abstract] [Full Text]
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G. C. Roman From UBOs to Binswanger's Disease: Impact of Magnetic Resonance Imaging on Vascular Dementia Research Stroke, August 1, 1996; 27(8): 1269 - 1273. [Full Text]
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W.T. Longstreth, T. A. Manolio, A. Arnold, G. L. Burke, N. Bryan, C. A. Jungreis, P. L. Enright, D. O'Leary, and L. Fried Clinical Correlates of White Matter Findings on Cranial Magnetic Resonance Imaging of 3301 Elderly People: The Cardiovascular Health Study Stroke, August 1, 1996; 27(8): 1274 - 1282. [Abstract] [Full Text]
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N. Watanabe, Y. Imai, K. Nagai, I. Tsuji, H. Satoh, M. Sakuma, H. Sakuma, J. Kato, N. Onodera-Kikuchi, M. Yamada, et al. Nocturnal Blood Pressure and Silent Cerebrovascular Lesions in Elderly Japanese Stroke, August 1, 1996; 27(8): 1319 - 1327. [Abstract] [Full Text]
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