A 55 year old man with progressive neurologic deficits

Article Sidebar

PDF
Published: Aug 29, 2009
Abstract Viewed: 421
PDF Downloaded: 78
Keywords:
Binswanger disease irregular white matter abnormalities multiple lacunar infarcts

Main Article Content

Sendjaja Muljadi
Department of Neurology, Medical Faculty, Trisakti University; Head of Neuroscience Centre, Medistra Hospital, Jakarta
Hardy Senjaya
Department of Anatomy, Mecical Faculty, Trisakti University, Jakarta

Abstract

At least 50 percent of the decline in functional abilities associated with the elderly is caused by neurological conditions, particularly vascular dementia, such as occurs in Binswanger disease. Binswanger disease is a rare condition, characterized by acute strokes with symptoms and signs compatible with lacunar infarction. The disease onset is commonly between 55 and 75 years. The majority of patients with Binswanger disease have chronic hypertension and other putative factors including diabetes mellitus, polycythemia, thrombocytosis, hyperlipidemia, hyperglobulinemia and pseudoxanthoma elasticum, increased fibrinogen levels and the antiphospholipid antibody syndrome. We report the case of a 55 year-old man, who suffered from involuntary movements of his right arm, slight hemiparesis on the right side, and also had dementia. He had a history of high blood pressure and laboratory tests showed that he had diabetes mellitus. The brain magnetic resonance imaging showed irregular white matter abnormalities with multiple lacunar infarcts in the basal ganglia and pons. The clinical picture is characterized by acute strokes, followed by involuntary movements and also dementia. Therefore we decided to diagnose it as Binswanger disease. After discharge from hospital, the patient has not returned for follow-up.

Article Details

How to Cite
Muljadi, S., & Senjaya, H. (2009). A 55 year old man with progressive neurologic deficits. Universa Medicina, 28(2), 127–132. Retrieved from https://univmed.org/ejurnal/index.php/medicina/article/view/238
Issue
Vol. 28 No. 2 (2009)
Section
Review Article

The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.

References

Roman GC. A historical review of the concept of vascular dementia: lessons from the past for the future. Alzheimer Dis Assoc Disord 1999;13(suppl 3):S4–S8.

Hurley RA, Tomimoto H, Akiguchi I, Fisher RE, Taber KH. Binswanger’s disease: an ongoing controversy. J Neuropsychiatry Clin Neurosci 2000;12:301-4.

Tomimoto H, Akiguchi I, Wakita H, Osaki A, Hayashi M, Yamamoto Y. Coagulation activation in patients with Binswanger disease. Arch Neurol 1999;56:1104-8.

Román GC. New Insight Into Binswanger disease. Arch Neurol 1999;56:1061-2.

Nagaratnam N, Nagaratnam K. Psychiatric and behavioral aspects of dementia of the Binswanger type. Am J Alzheimer’s Dis Other Demen 1998; 13:173-8.

National Institute of Neurological Disorders and Stroke. NINDS Binswanger’s disease information Page. Available at: http://www.ninds.nih.gov/disorders/binswangers/binswangers.htm . Accessed July 1, 2009.

Farkas E, Luiten PG. Cerebral microvascular pathology in aging and Alzheimer’s disease. Prog Neurobiol 2001;64:575–611.

Fernando MS, Simpson JE, Matthews F, Brayne C, Lewis CE, Barber R, et al. White matter lesions in an unselected cohort of the elderly: Molecular pathology suggests origin from chronic hypoperfusion injury. Stroke 2006;37:1391–8.

Droste DW, Ritter MA, Dittrich R, Heidenreich S, Wichter T, Freund M, et al. Arterial hypertension and ischaemic stroke. Acta Neurol Scand 2003;107:241–51.

Iadecola C, Davisson RL. Hypertension and cerebrovascular dysfunction. Cell Metab 2008;7:476–84.

Gilroy J. Binswanger Disease. In: Basic Neurology. 3rd ed. U.S.A, New York: The McGraw-Hill Companies, Inc; 2000.p.261-2.

Olsen CG, Clasen ME. Senile dementia of the Binswanger’s type. American Academy of Family Physicians. Available at: http://www.aafp.org/afp/AFPprinter/981200ap/olsen.html?print=yes. Accessed July 1, 2009.

Palumbo V, Boulanger JM, Hill MD, Inzitri D, Buchan AM. Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke. Neurology 2007;68:1020-4.

Kohshiro F, Sadaharu T, Hiroaki H, Mitsuko S. Binswanger’s disease: clinical and computed tomograph neuroradiological study of seven cases. Psychogeriatrics 2005;5:127-46.

Hanyu H, Asano T, Sakurai H, Iwamoto T, Takasaki M, Shindo H, et al. Magnetization transfer ratio in cerebral white matter lesions of Binswanger’s disease. J Neurol Sci 1999;166:85–90.

Choi SH, Na DL, Chung CS. Diffusion-weighted MRI in vascular dementia. Neurology 2000;54:83–9.

Puls I, Hauck K, Demuth K, Horowski A, Schlieber M, Dörfler P, et al. Diagnostic impact of cerebral transit time in the identification of microangiopathy in dementia: a transcranial ultrasound study. Stroke 1999;30:2291-5.

Lim GT, Mendez MF, Bronstein YL, Jouben-Steele L, Vinters HV. Clinicopathologic case report: akinetic mutism with findings of white matter hyperintensity. J Neuropsychiatry Clin Neurosci 2002;14:214-21.