THE SIGNIFICANCE OF CEREBRAL WHITE-MATTER ABNORMALITIES 100 YEARS AFTER BINSWANGERS REPORT - A REVIEW

Background Changes in the cerebral hemispheric white matter are detect ed with increasing frequency by CT and MRI among persons older than 60 years. The pathogenesis, clinical significance, and morphological sub strate of these changes are incompletely understood. Patients who have such neuroimaging abnormalities are sometimes diagnosed with ''Binswa nger's disease,'' an eponym that has generated much confusion because of its imprecise meaning. The objectives of this study were to determi ne whether the term Binswanger's disease merits acceptance as a distin ct clinicopathologic entity, to deduce the clinical significance of th ese white matter abnormalities from the analysis of appropriate public ations, 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 conductin g a Medline search, reviewed more than 160 publications, mostly in the English language, on the subject of white matter abnormalities detect able by currently used neuroimaging methods (ie, leukoaraiosis). Concl usions Binswanger's original description appears to be insufficient fo r the purpose of defining a new nosological entity. After evaluating t he vaguely outlined pathological correlates described in a few of thes e subcortical cerebral leukoencephalopathies, we conclude that the cli nical significance of leukoaraiosis remains incompletely defined. Howe ver, its frequency increases with age independent of other risk factor s, and in nondemented subjects leukoaraiosis is associated with defici ts 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.