Binswanger's disease: clinical and computed tomography neuroradiological study of seven cases

Background: Binswanger's disease is a special type of vascular dementia, which requires further reappraisal and redefinition. In a geriatric psychiatry hospital (with 207 beds), we treated several patients who probably had this disease, and tried to establish a basis for making a clinical diagnosis. Methods: From 2001 to 2005, we treated seven inpatients with noteworthy symptoms, who had been under observation in hospital wards for between 4 and 19 months. Here, for these patients, we examine the history of the illness, the condition of the patients at admission, the clinical course, and serial computed tomography (CT) findings. Results: Characteristic features of the clinical courses and symptoms of these patients were: (i) onset occurred late in life (patients were aged in their 70s and 80s); (ii) vascular events were atypical and transient, leaving few permanent neurological sequelae; (iii) progression of dementia and other somatic or neurologic symptoms was continuous and fast in four patients, and rather gradual in three patients; (iv) there was an alternating or changing pattern in all patients’ state of consciousness, mood, behavior, or manner of respiration; symptoms such as mutism, lack of facial expression, and apparent indifference were counterbalanced with such behaviors as occasional unexpected smiles, pertinent verbal responses, and sincere gazes; (v) significant negative symptoms were a lack of dysarthria, lack of dysphagia, lack of involuntary movement, and occasional lack of muscle rigidity. The primary CT findings were: (i) moderate to severe generalized (involving whole of centrum semiovale), diffuse and homogeneous (except one patient) leukoaraiosis of the hemispheric white matter, including the temporal lobe (except one patient), all (except one patient) frontal and parietal dominant, with the corpus callosum involved in one case; (ii) diffuse and generalized atrophy of the pallium, most marked in the frontal and parietal lobes, restricted to the frontal and parietal lobes in three patients, and to the frontal, parietal and temporal lobes in four patients; (iii) atrophy of the medial temporal lobe was inconstant and, when present, ambiguous in degree; (iv) slight to moderate enlargement of the bilateral lateral and third ventricles; (v) a few small lacunae in the basal ganglia and thalamus in one patient, inhomogeneous macular changes of density in the basal ganglia and thalamus in two patients, and no such findings in the remaining four patients. Conclusion: We have described a group of patients with dementia characterized by a clinical course with episodes of rather transient vascular intervention, psychopathology characteristic of organic dementia, fluctuating psychotic symptoms in combination, and intensive extensive homogeneous leukoaraiosis of the hemispheric white matter on CT. These clinical and CT neuroradiological findings seem to warrant the clinical diagnosis of Binswanger's disease, which should be reconfirmed at autopsy. Early research on this disease by Binswanger, Alzheimer, Nissl and others is reviewed. Some points of differential diagnosis in serial neuroradiology are discussed in relation to multilacunar dementia.     

急性脑卒中患者血浆Hcy 与脑白质疏松、 PSCAD 的相关性分析

目的 探讨急性脑卒中患者血浆同型半胱氨酸（Hcy）与脑白质疏松、卒中后焦虑抑郁共病 （PSCAD）的关系。方法 回顾性分析270 例急性脑卒中患者临床资料,按照脑白质疏松（LA）严重程度分 为轻度LA 组和中重度LA 组,按照是否存在PSCAD 状态分为PSCAD 组和非PSCAD 组,所有患者均于入 院后第2 天抽取肘静脉血检测血浆Hcy 水平,分析血浆Hcy 水平与LA、PSCAD 的关系。结果 中重度LA 组患者年龄、高血压、吸烟、中重度梗死及血浆Hcy 水平高于轻度LA 组（P <0.05）,PSCAD 组高血压、饮 酒、基底节区和额叶区梗死、中重度梗死及血浆Hcy 水平高于非PSCAD 组（P <0.05）;年龄、高血压及血 浆Hcy 水平是中重度LA 的独立危险因素（P <0.05）,饮酒、血浆Hcy 水平是PSCAD 的独立危险因素（P <0.05）。 血浆Hcy 水平与LA、PSCAD 呈正相关（P <0.05）。结论 通过检测血浆Hcy 水平能够在一定程度上反应 LA 病情和焦虑抑郁程度,为临床治疗和预后监测提供依据。     

脑白质疏松相关性轻度认知功能障碍与血浆同型半胱氨酸的关系

目的 探讨脑白质疏松(LA)患者合并轻度认知功能障碍(MCI)与血浆同型半胱氨酸(Hcy)的关系.方法 选择2011年8月～2013年1月在中国医科大学附属第一医院老年病科住院的LA患者110例和非LA患者(对照组)40例.将LA患者分为MCI组(LA+MCI,60例)与认知功能正常组(LA,50例).LA患者根据Hcy水平分为低水平(Hcy<16μmol/L,31例),中间水平(16μmol/L≤Hcy≤29μmol/L,45例),高水平(Hcy≥30μmol/L组,34例).采用简易精神状态量表(MMSE),蒙特利尔认知评估中文版(MoCA)和日常生活能力量表(ADL)对各组患者进行认知功能评定.结果 与对照组相比较,LA组和LA+MCI组的Hcy水平显著升高(均为P<0.01).LA患者MoCA评分与空腹血糖水平及Hcy水平呈负相关(均为P<0.01).与Hcy低水平患者比较,中间水平和高水平患者MoCA评分值显著降低(P<0.05),且高水平患者评分值较中间水平患者更低(P<0.05).结论 LA合并MCI患者的血浆Hcy水平升高,且Hcy的水平越高、认知功能评分越低.     

脑白质疏松与认知功能的关系研究

目的:评估脑白质疏松(LA)与认知功能的关系。方法:253例患者依据有无LA表现分为LA组127例和对照组126例,LA组根据年龄相关白质变化分级量表(ARWMCRs)评分又分为轻度亚组36例、中度亚组48例、重度亚组43例。应用简明精神状态量表(MMSE)和蒙特利尔认知评估量表北京版(MoCA)评估患者认知功能。结果:LA组与对照组相比,患有高血压、糖尿病的比例升高,差异有统计学意义(P<0.05)。中、重度亚组与对照组相比,MMSE和MoCA评分显著降低,差异有统计学意义(P<0.05)。LA组与对照组相比,在视空间与执行、命名能力、注意力、语言能力、抽象能力、延迟记忆能力、定向力7个认知域的评分差异均有统计学意义(P<0.05)。ARWMCRs评分与MMSE、MoCA评分呈负相关(P<0.01)。结论:LA与老年患者认知功能密切相关。     

From eyes‐closed to eyes‐open: Role of cholinergic projections in EC‐to‐EO alpha reactivity revealed by combining EEG and MRI

Alpha rhythm (8 to 12 Hz) observed in EEG over human posterior cortex is prominent during eyes‐closed (EC) resting and attenuates during eyes‐open (EO) resting. Research shows that the degree of EC‐to‐EO alpha blocking or alpha desynchronization, termed alpha reactivity here, is a neural marker of cognitive health. We tested the role of acetylcholine in EC‐to‐EO alpha reactivity by applying a multimodal neuroimaging approach to a cohort of young adults and a cohort of older adults. In the young cohort, simultaneous EEG‐fMRI was recorded from twenty‐one young adults during both EO and EC resting. In the older cohort, functional MRI was recorded from forty older adults during EO and EC resting, along with FLAIR and diffusion MRI. For a subset of twenty older adults, EEG was recorded during EO and EC resting in a separate session. In both young and older adults, functional connectivity between the basal nucleus of Meynert (BNM), the major source of cortical acetylcholine, and the visual cortex increased from EC to EO, and this connectivity increase was positively associated with alpha reactivity; namely, the stronger the BNM‐visual cortex functional connectivity increase from EC to EO, the larger the EC‐to‐EO alpha desynchronization. In older adults, lesions of the fiber tracts linking BNM and visual cortex quantified by leukoaraiosis volume, associated with reduced alpha reactivity. These findings support a role of acetylcholine and particularly cholinergic pathways in mediating EC‐to‐EO alpha reactivity and suggest that impaired alpha reactivity could serve as a marker of the integrity of the cholinergic system.     

Rho激酶抑制剂对缺血性脑白质损伤的实验性干预研究

目的探讨Rho激酶对缺血性脑白质损害的影响及Rho激酶抑制剂对缺血性脑白质损害的干预效果。方法雄性Wistar大鼠60只,随机分为对照组、缺血组和治疗组,每组20只。缺血组和治疗组给予双侧颈总动脉结扎,对照组给予假手术处理;术后治疗组给予法舒地尔腹腔注射,对照组和缺血组给予生理盐水腹腔注射。手术1个月后评价测定各组大鼠脑深部白质纤维密度、星形胶质细胞数目以及Rho激酶mRNA表达水平。结果缺血组大鼠脑深部白质纤维密度较对照组明显降低,星形胶质细胞数目明显增多,Rho激酶mRNA表达水平明显增高,差异有统计学意义(P<0.05);治疗组大鼠脑深部白质纤维密度较缺血组明显增高,星形胶质细胞数目明显减少,差异有统计学意义(P<0.05)。结论 Rho激酶异常活化与缺血性白质损害相关,Rho激酶抑制剂可改善慢性低灌注状态下大鼠脑白质损害。     

半胱氨酸蛋白酶抑制剂C与脑白质疏松相关性研究

目的探讨半胱氨酸蛋白酶抑制剂C(CYSC)水平与脑白质疏松的相关性及不同程度脑白质疏松患者血清CYSC水平的差异。方法选择213例脑白质疏松患者(脑白质疏松组)和201名健康体检者(对照组)为研究对象。应用胱抑素C检测试剂盒(乳胶增强免疫比浊法)检测血清CYSC水平,收集临床资料和脑白质疏松的相关可能危险因素,采用MRI的Fazekas方法对脑白质疏松组进行分级,评估不同程度脑白质疏松患者的CYSC水平差异。结果脑白质疏松组的高血压病、糖化血红蛋白、肾功能、同型半胱氨酸和CYSC水平[(0.99±0.28)mg·L~(-1)]与对照组[(0.80±0.20)mg·L~(-1)]比较,差异有统计学意义(P0.05),提示这些因素和CYSC水平与脑白质疏松的发生和严重程度相关。结论对不同脑白质疏松患者进行影像学Fazekas分级后发现,随着Fazekas评分增加CYSC水平随之升高。     

血压及其变异性与脑白质疏松症的相关性研究进展

脑白质疏松症是指脑室周围或皮质下区(半卵圆中心)弥漫性非特异性白质损害。脑白质疏松症可以增加脑卒中的风险,并与认知功能下降和运动障碍等密切相关。已有研究认为高血压病是脑白质疏松症最主要的危险因素。但随着对脑白质疏松症形成的病理生理机制研究的不断完善,学者们发现低血压及血压变异性也与脑白质疏松症相关。文中旨在对血压及其变异性与脑白质疏松症之间的联系研究进行综述。     

tPA treatment for acute ischaemic stroke in patients with leukoaraiosis

Background and Purpose: Whether leukoaraiosis on baseline CT is associated with an increased risk of symptomatic intracerebral haemorrhage (sICH) or poor outcome following tissue plasminogen activator (tPA) treatment for acute ischaemic stroke is still a matter of debate. Objective: To investigate the relationship between the presence and severity of leukoaraiosis on baseline CT and the risk of sICH and functional outcome after tPA treatment for acute ischaemic stroke. Methods: A single‐center observational cohort study with a retrospective analysis on consecutive patients with ischaemic stroke treated with tPA in the period 2002–2008. Outcome measures were the occurrence of sICH and functional outcome at 3 months. Results: Of the 400 patients, 24% had leukoaraiosis on their baseline CT. Eleven patients (11%) with leukoaraiosis versus thirteen (4%) patients without leukoaraiosis had a sICH [odds ratio (OR) 2.85 95%‐CI 1.23–6.60, P = 0.02]. Multivariate analysis showed a non‐significant trend towards an association of leukoaraiosis and sICH (OR 1.9, 95%‐CI 0.78–4.68, P = 0.16). Leukoaraiosis was independently associated with poor functional outcome (OR 2.39, 95%‐CI 1.21–4.72, P = 0.01). No difference was observed in the outcome measures amongst patients with moderate or severe leukoaraiosis. Conclusion: Our study demonstrates that patients treated with tPA and leukoaraiosis on their baseline CT are at greater risk of sICH and have a worse functional outcome compared to patients without leukoaraiosis. It is important to note that these results should not lead to exclusion of patients with leukoaraiosis for tPA treatment.     

脑白质疏松症患者的认知水平与血浆同型半胱氨酸水平和颈部血流动力学的相关性

目的 探讨脑白质疏松症(LA)患者认知功能、血浆同型半胱氨酸(Hcy)水平与颈动脉血流动力学指标的关系.方法 测试LA患者认知损害水平,根据结果分为三组,分别为痴呆组、轻度认知功能障碍组和无认知功能障碍组.根据三组患者的血浆Hcy水平及颈部血管超声血流动力学指标进行相关性分析.结果 痴呆组患者的血浆Hcy水平较轻度认知功能障碍组与无认知功能障碍组增高(P<0.05),双侧颈内动脉阻力指数(RI)、搏动指数(PI)亦较轻度认知功能障碍组与无认知功能障碍组增高(P<0.05).结论LA患者不同水平认知功能与血浆Hcy水平和颈部血管超声变化存在相关性,血浆Hcy水平越高,RI和PI越高,则认知损害越重.