Abstract
A clinicopathological study was performed on 45 cases of the elderly persons, who showed the pathological changes of progressive subcortical vascular encephalopathy of Binswanger type. The results were as follows :
1) Progressive subcortical vascular encephalopathy (PSVE) was observed in 3.8% of all autopsies of the elderly persons and consisted of 6.7% of the brains with cerebrovascular diseases. The grades of the white matter lesions were divided into I-III (slight to severe) for analysis. Small infarcts in the basal ganglia, thalamus and pons were usually observed, but cerebral cortex was generally preserved.
2) Neuropsychiatric symptoms were dementia, urinary incontinence, hemiplegia, pseudobulbar palsy, psychosis, parkinsonism, mutism, etc. Cases of grade III showed a pseudobulbar palsy, parkinsonism and mutism in high incidence. There were also NPH cases in this series.
3) Pathologically almost all cases showed a marked cerebral arteriosclerosis. Angionecrosis was observed in 60-80%. Fibrotic and stenotic changes of the blood vessels in the deep white matter were also remarked, particularly in 90% in the cases of grade III.
4) As the pathomechanism and etiologic factors of PSVE, it is considered that various complications, such as hypertension, cardiac disease, malnutrition, etc., may play an important role for PSVE, when they occurred in the elderly persons with a history of hypertension of long duration, marked cerebral arteriosclerosis and arteriolar changes in the white matter.
