Encefalopatia subcortical arteriosclerótica de binswanger: forma especial de demência associada a hipertensão arterial sistêmica

Oliveira, Acary Souza Bulle; Massaro, Ayrton Roberto; Campos, Carlos José Reis de; Zukerman, Eliova

doi:10.1590/S0004-282X1986000300005

Resumos

A encefalopatia subcortical arteriosclerótica de Binswanger constitui forma especial de demência associada à hipertensão arterial sistêmica, caracterizada por processo aterosclerótico pronunciado nos vasos da substância branca subcortical, poupando o córtex. Com a devida valorização do quadro clínico e sobretudo a utilização da tomografia computadorizada cerebral, é possível o diagnóstico em vida. Relatamos três casos que apresentavam como características principais: presença de hipertensão arterial sistêmica, início de instalação da doença entre 50 e 70 anos, evolução subaguda, comprometimento mental predominante, com pobreza de sinais neurológicos e sobretudo tomografia computadorizada cerebral característica, com hipodensidade subcortical bilateral e simétrica. Em um dos pacientes, que faleceu, foi realizada arteriografia cerebral. Esta evidenciou trombose na artéria carótida interna e pobreza de circulação no território das artérias tálamo-estriadas bilateralmente, principalmente à direita. Os outros dois pacientes, encontram-se sob acompanhamento ambulatorial, fazendo uso de anti-hipertensivos, evoluindo aparentemente com estabilização do quadro neurológico. Apesar de se conseguir identificação bem definida desta doença com características clínicas, tomográficas e etiopatogênicas próprias, ainda ela continua a ser pouco relatada. Seu diagnóstico deve ser considerado com maior freqüência porque, apesar de não existir tratamento efetivo até o momento, é possível tentar sua prevenção mediante controle adequado de hipertensão arterial sistêmica, fator este que parece estar intimamente ligado à sua gênese.

This encephalopathy is characterized by an important artheriosclerotic involvement of the vessels of the cerebral white matter and a difuse subcortical demyelination, sparing the cortex. The diagnosis is presently possible, ante mortem, by connecting the clinical picture with the CT scan findings, which are essential. Three cases with Binswanger encephalopathy are reported and the following picture was found: age 50 to 70 years old at the onset; dementia with scanty neurological signs; systhemic arterial hypertension; subacute course of the disease; and a CT scan, highly characteristic, that shows bilateral and symmetric subcortical hypodensity. In one of the patients, that eventually died, an angiography disclosed a right internal carotid thrombosis and a diminished flow in the thalamic striate arteries in both sides. The other two patients are aparently stabilized with anti-hypertensive medication. Binswanger encephalopathy is still seldom described in spite of being a very well defined entity. This diagnosis should be considered much more frequently because it is possible to prevent the encephalopathy avoiding systemic hypertension that is probably intimately linked with the genesis of the disease.

Encefalopatia subcortical arteriosclerótica de binswanger: forma especial de demência associada a hipertensão arterial sistêmica

Subcortical arteriosclerotic encephalopathy of Binswanger: a special form of dementia associated with systemic arterial hypertension

Acary Souza Bulle Oliveira^I; Ayrton Roberto Massaro^II; Carlos José Reis de Campos^III; Eliova Zukerman^IV

^IPós-graduando em Neurologia - Trabalho realizado na Disciplina de Neurologia da Escola Paulista de Medicina

^IIResidente - Trabalho realizado na Disciplina de Neurologia da Escola Paulista de Medicina

^IIIProfessor Adjunto Doutor em Neurologia - Trabalho realizado na Disciplina de Neurologia da Escola Paulista de Medicina

^IVProfessor Adjunto e Chefe do Depto. de Neurologia e Neurocirurgia - Trabalho realizado na Disciplina de Neurologia da Escola Paulista de Medicina

RESUMO

A encefalopatia subcortical arteriosclerótica de Binswanger constitui forma especial de demência associada à hipertensão arterial sistêmica, caracterizada por processo aterosclerótico pronunciado nos vasos da substância branca subcortical, poupando o córtex. Com a devida valorização do quadro clínico e sobretudo a utilização da tomografia computadorizada cerebral, é possível o diagnóstico em vida. Relatamos três casos que apresentavam como características principais: presença de hipertensão arterial sistêmica, início de instalação da doença entre 50 e 70 anos, evolução subaguda, comprometimento mental predominante, com pobreza de sinais neurológicos e sobretudo tomografia computadorizada cerebral característica, com hipodensidade subcortical bilateral e simétrica. Em um dos pacientes, que faleceu, foi realizada arteriografia cerebral. Esta evidenciou trombose na artéria carótida interna e pobreza de circulação no território das artérias tálamo-estriadas bilateralmente, principalmente à direita. Os outros dois pacientes, encontram-se sob acompanhamento ambulatorial, fazendo uso de anti-hipertensivos, evoluindo aparentemente com estabilização do quadro neurológico. Apesar de se conseguir identificação bem definida desta doença com características clínicas, tomográficas e etiopatogênicas próprias, ainda ela continua a ser pouco relatada. Seu diagnóstico deve ser considerado com maior freqüência porque, apesar de não existir tratamento efetivo até o momento, é possível tentar sua prevenção mediante controle adequado de hipertensão arterial sistêmica, fator este que parece estar intimamente ligado à sua gênese.

SUMMARY

This encephalopathy is characterized by an important artheriosclerotic involvement of the vessels of the cerebral white matter and a difuse subcortical demyelination, sparing the cortex. The diagnosis is presently possible, ante mortem, by connecting the clinical picture with the CT scan findings, which are essential. Three cases with Binswanger encephalopathy are reported and the following picture was found: age 50 to 70 years old at the onset; dementia with scanty neurological signs; systhemic arterial hypertension; subacute course of the disease; and a CT scan, highly characteristic, that shows bilateral and symmetric subcortical hypodensity. In one of the patients, that eventually died, an angiography disclosed a right internal carotid thrombosis and a diminished flow in the thalamic striate arteries in both sides. The other two patients are aparently stabilized with anti-hypertensive medication. Binswanger encephalopathy is still seldom described in spite of being a very well defined entity. This diagnosis should be considered much more frequently because it is possible to prevent the encephalopathy avoiding systemic hypertension that is probably intimately linked with the genesis of the disease.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

E. Zukerman - Rua Itacolowi. 601. 6° andar - 01239 - São Paulo, SP - Brasil.

1. ALZHEIMER, A. - Neuroarbeiten uber die Dementia senilis und die auf atherometoser Gefâsserkrankung basierenden Gehinerkrankungen. Monatschr. Psych. Neurol. 3: 101, 1898.
2. BARTON LANE, M.D. ; BARBARA, A.C. & TIMOTHY, A.P. - Computerized cranial tomography in cerebral disease of white matter. Neurology 28:534, 1978.
3. BEEVERS, D.C. : FAIRMAN, M.J.; HAMILTON, M. & HARPUR, J.E. - Antihypertensive treatment and the course of established cerebral vascular disease. Lancet 1:1407, 1973.
4. BIEMOND, A. - On Binswanger's subcortical arteriosclerotic encephalopathy and the possibility of its clinical recognition. Psychiat. Neurol. Neurochir. 73:413, 1970.
5. BINSWANGER O. - D.e Abgrenzung der algemeinen progressiven Paralyse. Berl. Klin. Wochschr. 31:1103, 1137, 1180, 1894.
6. BOUSSER, M.G. - Les conceptions actuelles des démences artériopathiques. I/Encéphale 3:357, 1977.
7. BRUST, J.C.M. - Dementia and cerebrovascular disease. Adv. Neurol. 38:131, 1983.
8. BURGER, P.C.; BURCH, J.G. & KUNZE, U. - Subcortical arteriosclerotic encephalopathy (Binswanger disease). Stroke 7:626, 1976.
9. CAPLAN, L.R. & SCHOENE, W.C. - Clinical features of subcortical arteriosclerotic encephalopathy (Binswanger disease). Neurology 28:1206, 1978.
10. CASTER, A.B. - Hypotensive therapy in stroke survivors. Lancet 1:485, 1970.
11. DAVISON, C. - Progressive subcortical encephalopathy (Binswanger disease). J. Neuropath, exp. Neurol. 1:42, 1942.
12. FARNEL, F.J. & GLOBUS, J.H. - Chronic progressive vascular subcortical encephalopathy: chronic progressive subcortical encephalits of Binswanger. Arch. Neurol. Psych. 27:593, 1932.
13. FEIGIN, I. & POPOH, N. - Neuropathological changes late in cerebral oedema: the relationship to trauma, hypertensive disease and Binswanger's encephalopathy. J. Neuropathol. exp. Neurol. 22:500, 1963.
14. GARCIN, R. ; LAPRESLE, J. & LYON, G. - Encéphalopatie souscorticale chronique de Binswanger: étude anatomo-clinique de trois observations. Rév. neurol. (Paris) 102:423, 1960.
15. HACHINSKI, V.C.; ILIFF, L.D. ; ZILHKA, E. ; Du BOULAY, G.H.; MAC ALLISTER, V.L. ; MARSHALL, J.; ROSS ROUSSELL, R.W. & SYMON, L. - Cerebral blood flow in dementia. Arch. Neurol. 32:632, 1975.
16. HARRISON, M. J.G. ; THOMAS, G.H. ; Du BOULAY, G.H. & MARSHALL, J. - Multi-infart dementia. J. neurol. Sci. 40:97, 1979.
17. JELLINGER; K. & NEUMAYER, E. - Progressive subcorticale vasculare Encéphalopatie Binswanger: eine klinisch-neuropathologische Studie. Arch. Psychiatr. Nervenkr. 205:523, 1964.
18. JELLINGER, K. - Neuropathological aspects of dementias resulting from abnormal blood and cerebrospinal fluid dynamics. Acta neurol. belg. 76:83, 1976.
19. KANNEL, W.B. ; DAWBER, T.R.; COHEN, M.E. & McNAMARA, P.M. - Vascular disease of the brain: epidemiologic aspects. The Framingham Study. Amer. J. public Health 55:1355, 1965.
20. LOEB, C. & GANDOLFO, C. - Diagnostic evaluation of degenerative and vascular aementia. Stroke 14: 399, 1983.
21. LOIZOD, L.A. ; KENDAL, B.E. & MARSHALL, J. - Subcortical arteriosclerotic encephalopathy: a clinical and radiological investigation. J. Neurol. Neurosurg. Psychiatr. 44:294, 1981.
22. MIKOL, J. - Maladie de Binswanger et formes aparentées: contribution à l'étude des leucoencéphalopathies artérioscléreuses. Rev. neurol. (Paris) 118:111, 1968.
23. OLSZEWSKI, J. - Subcortical arteriosclerotic encephalopathy. World Neurol. 3:359, 1962.
24. PULLIOINO, P.: ESKIN, T. & KETONEI. L. - Prevalence of Binswangers's disease. Lancet 1:939, 1983.
25. DeREUCH, J.; CREVITS, L. ; DeCOSTER, W. ; SIEBEN, G. & Van Der EECKEN, H. - Pathogenesis of Binswanger chronic progressive subcortical encephalopathy. Neurology 30:920, 1980.
26. ROSENBERG, G.A.; KORNFELD, M.; STOVRING, J. & BICKNELL, J.M. - Subcortical arteriosclerotic encephalopathy (Binswanger): computerised tomography. Neurology 129:1102, 1979.
27. SANDIK, R. - Subcortical arteriosclerotic encephalopathy (Binswangens disease). S. afr. medical J. 63:204, 1983.
28. STOCHDORPH, O. & MESSEN, H. - Die arteriosklerotische und die hypertonische hirner Krankung - Handbuch spez. path. Anat. Histol. 13/1B:1465, 1957.
29. SYMON, L,.; PASZTOR, E. & DORSCH, N.W.C. - Physiological responses of local areas of the cerebral circulation in experimental primates determined by the method of hydrogen clearance. Stroke 4:632, 1973
30. TORVIK, A. & SKULLERUD, K. - How often are brain infarct caused by hypotensive episodes. Stroke 7:255, 1976.
31. Van BOGAERT, L. - Encéphalopathie sous-corticale progressive (Binswanger) à evolution rapide chez soeurs. Greek Medicine 24:3, 1955.
32. Van BOGAERT, L. & MARTIN, J.J. - Analyse critique de la pathologie de l'angiomatose cérébroméningée diffuse non calcificante et de 1'encéphalopathie de Binswanger. J. neurol. Sci., 14:301, 1971.
33. WODARZ, R. - Watershed infarctions and computed tomography: a topographical study in cases with sclerosis or occlusion of the carotid artery. Neuroradiology 19:245, 1980.

Datas de Publicação

Publicação nesta coleção
29 Jun 2011
Data do Fascículo
Set 1986

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALZHEIMER, A. - Neuroarbeiten uber die Dementia senilis und die auf atherometoser Gefâsserkrankung basierenden Gehinerkrankungen. Monatschr. Psych. Neurol. 3: 101, 1898.

[2] 2. BARTON LANE, M.D. ; BARBARA, A.C. & TIMOTHY, A.P. - Computerized cranial tomography in cerebral disease of white matter. Neurology 28:534, 1978.

[3] 3. BEEVERS, D.C. : FAIRMAN, M.J.; HAMILTON, M. & HARPUR, J.E. - Antihypertensive treatment and the course of established cerebral vascular disease. Lancet 1:1407, 1973.

[4] 4. BIEMOND, A. - On Binswanger's subcortical arteriosclerotic encephalopathy and the possibility of its clinical recognition. Psychiat. Neurol. Neurochir. 73:413, 1970.

[5] 5. BINSWANGER O. - D.e Abgrenzung der algemeinen progressiven Paralyse. Berl. Klin. Wochschr. 31:1103, 1137, 1180, 1894.

[6] 6. BOUSSER, M.G. - Les conceptions actuelles des démences artériopathiques. I/Encéphale 3:357, 1977.

[7] 7. BRUST, J.C.M. - Dementia and cerebrovascular disease. Adv. Neurol. 38:131, 1983.

[8] 8. BURGER, P.C.; BURCH, J.G. & KUNZE, U. - Subcortical arteriosclerotic encephalopathy (Binswanger disease). Stroke 7:626, 1976.

[9] 9. CAPLAN, L.R. & SCHOENE, W.C. - Clinical features of subcortical arteriosclerotic encephalopathy (Binswanger disease). Neurology 28:1206, 1978.

[10] 10. CASTER, A.B. - Hypotensive therapy in stroke survivors. Lancet 1:485, 1970.

[11] 11. DAVISON, C. - Progressive subcortical encephalopathy (Binswanger disease). J. Neuropath, exp. Neurol. 1:42, 1942.

[12] 12. FARNEL, F.J. & GLOBUS, J.H. - Chronic progressive vascular subcortical encephalopathy: chronic progressive subcortical encephalits of Binswanger. Arch. Neurol. Psych. 27:593, 1932.

[13] 13. FEIGIN, I. & POPOH, N. - Neuropathological changes late in cerebral oedema: the relationship to trauma, hypertensive disease and Binswanger's encephalopathy. J. Neuropathol. exp. Neurol. 22:500, 1963.

[14] 14. GARCIN, R. ; LAPRESLE, J. & LYON, G. - Encéphalopatie souscorticale chronique de Binswanger: étude anatomo-clinique de trois observations. Rév. neurol. (Paris) 102:423, 1960.

[15] 15. HACHINSKI, V.C.; ILIFF, L.D. ; ZILHKA, E. ; Du BOULAY, G.H.; MAC ALLISTER, V.L. ; MARSHALL, J.; ROSS ROUSSELL, R.W. & SYMON, L. - Cerebral blood flow in dementia. Arch. Neurol. 32:632, 1975.

[16] 16. HARRISON, M. J.G. ; THOMAS, G.H. ; Du BOULAY, G.H. & MARSHALL, J. - Multi-infart dementia. J. neurol. Sci. 40:97, 1979.

[17] 17. JELLINGER; K. & NEUMAYER, E. - Progressive subcorticale vasculare Encéphalopatie Binswanger: eine klinisch-neuropathologische Studie. Arch. Psychiatr. Nervenkr. 205:523, 1964.

[18] 18. JELLINGER, K. - Neuropathological aspects of dementias resulting from abnormal blood and cerebrospinal fluid dynamics. Acta neurol. belg. 76:83, 1976.

[19] 19. KANNEL, W.B. ; DAWBER, T.R.; COHEN, M.E. & McNAMARA, P.M. - Vascular disease of the brain: epidemiologic aspects. The Framingham Study. Amer. J. public Health 55:1355, 1965.

[20] 20. LOEB, C. & GANDOLFO, C. - Diagnostic evaluation of degenerative and vascular aementia. Stroke 14: 399, 1983.

[21] 21. LOIZOD, L.A. ; KENDAL, B.E. & MARSHALL, J. - Subcortical arteriosclerotic encephalopathy: a clinical and radiological investigation. J. Neurol. Neurosurg. Psychiatr. 44:294, 1981.

[22] 22. MIKOL, J. - Maladie de Binswanger et formes aparentées: contribution à l'étude des leucoencéphalopathies artérioscléreuses. Rev. neurol. (Paris) 118:111, 1968.

[23] 23. OLSZEWSKI, J. - Subcortical arteriosclerotic encephalopathy. World Neurol. 3:359, 1962.

[24] 24. PULLIOINO, P.: ESKIN, T. & KETONEI. L. - Prevalence of Binswangers's disease. Lancet 1:939, 1983.

[25] 25. DeREUCH, J.; CREVITS, L. ; DeCOSTER, W. ; SIEBEN, G. & Van Der EECKEN, H. - Pathogenesis of Binswanger chronic progressive subcortical encephalopathy. Neurology 30:920, 1980.

[26] 26. ROSENBERG, G.A.; KORNFELD, M.; STOVRING, J. & BICKNELL, J.M. - Subcortical arteriosclerotic encephalopathy (Binswanger): computerised tomography. Neurology 129:1102, 1979.

[27] 27. SANDIK, R. - Subcortical arteriosclerotic encephalopathy (Binswangens disease). S. afr. medical J. 63:204, 1983.

[28] 28. STOCHDORPH, O. & MESSEN, H. - Die arteriosklerotische und die hypertonische hirner Krankung - Handbuch spez. path. Anat. Histol. 13/1B:1465, 1957.

[29] 29. SYMON, L,.; PASZTOR, E. & DORSCH, N.W.C. - Physiological responses of local areas of the cerebral circulation in experimental primates determined by the method of hydrogen clearance. Stroke 4:632, 1973

[30] 30. TORVIK, A. & SKULLERUD, K. - How often are brain infarct caused by hypotensive episodes. Stroke 7:255, 1976.

[31] 31. Van BOGAERT, L. - Encéphalopathie sous-corticale progressive (Binswanger) à evolution rapide chez soeurs. Greek Medicine 24:3, 1955.

[32] 32. Van BOGAERT, L. & MARTIN, J.J. - Analyse critique de la pathologie de l'angiomatose cérébroméningée diffuse non calcificante et de 1'encéphalopathie de Binswanger. J. neurol. Sci., 14:301, 1971.

[33] 33. WODARZ, R. - Watershed infarctions and computed tomography: a topographical study in cases with sclerosis or occlusion of the carotid artery. Neuroradiology 19:245, 1980.