PURE SUBCORTICAL ARTERIOSCLEROTIC ENCEPHALOPATHY (BINSWANGER DISEASE) - A CLINICOPATHOLOGICAL STUDY .2. PATHOLOGICAL FEATURES

We studied 14 autopsy-verified cases of pure subcortical arteriosclerotic encephalopathy and related findings to symptoms and signs (c.f. part 1). Subserial whole brain sections showed: (i) stenotic-occlusive microangiopathy affecting penetrating arteries and atherosclerosis of larger leptomeningeal arteries, (ii) widespread bilateral incomplete lesions of hemispheric white matter and multiple lacunes supratentorially in the centrum semiovale, the striatum, the thalamus, the internal capsule, and, to a lesser extent infratentorially; (iii) widening of the lateral and the third ventricles secondary to surrounding extensive brain tissue damage. Mainly slowly progressive gait disturbance, urinary incontinence, dementia and pure motor strokes were noted in such cases with severely lesioned periventricular white matter, multiple lacunes and hydrocephalus ex vacuo.