Abstract
An autpsied case of Binswanger disease with bilateral corticospinal tract (pyramidal tract) degeneration was reported. A 68-year old man who had a history of hypertension and cerebral infarction showed progressive dementia with involvement of affect and volition, pseudobulbar palsy and pyramidal signs. Pathologically, a severe general atherosclerosis was observed. In the cerebrum, especially in the frontal lobes, diffuse myelin pallor and severe loss of axons was found in the deep white matter, despite of sparing of U-fibers. There were multiple small infarctions and severe arteriosclerosis of small arteries or of arterioles in the white matter, basal ganglia, thalamus, internal capsules and pontine basis. In addition, there was a bilateral corticospinal tract degeneration with severe loss of myelin and axons extending from the white matter in the precentral gyri through the posterior limbs of internal capsules to the spinal cords. To our knowledge, there has been no report of Binswanger disease associated with bielateralcorticospinal tract degeneration. Therefore this case was very rare and interesting. We discussed the pathogenesis of the bilateral corticospinal tract degeneration in this case and the relationships between the dementia and the cerebral white matter lesions.
