Binswanger's disease is not a single entity

The clinicopathological findings reported by Binswanger are insufficient to qualify as distinct entity the condition named "Binswanger's disease", and subsequently by Olszewski (1962) "subcortical arteriosclerotic encephalopa thy (SAE) (Binswanger's type)". A short summary of the characteristic patho logical, clinical and neuroimaging features of SAE is reported. The white m atter changes detected by neuroimaging must be considered aspecific, since identical changes may be found in normal elderly as well as in patients wit h different diseases: different biochemical mechanisms can undoubtedly unde rlie identical neuroimaging patterns. Two other relevant points are notewor thy: the occurrence of pathological features of SAE in other diseases (CADA SIL, pseudoxanthoma elasticum, antiphospholipid antibody syndrome) and the observation of some patients with pathological changes of SAE but an incomp lete clinical picture. The clinicopathological features described as Binswa nger's disease do not qualify as a separate entity since they are common to a variety of illnesses. The pathological picture identified by Olszewski c an rightly be named, according to Caplan, "chronic microvascular leukoencep halopathy" (CML). The clinicopathological features of the so-called Binswan ger's disease constitute a syndrome, the CML syndrome (CMLS), which can be found in some hereditary diseases and in acquired conditions. This syndrome shows peculiar cerebrovascular changes and, when clinically associated wit h dementia, identifies one of the subtypes of vascular dementia.