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Rahmatullaeva Nasiba Islambaevna, assistant of the Department of Neurology Andijan State Medical Institute Rakhimbaeva Gulnara Sattarovna, Head of the Department of Nervous Diseases, professor
Tashkent Medical Academy Nasirdinova Nargisa Askarovna, associate professor of the Department of Neurology Andijan State Medical Institute E-mail: karimova60@mail.ru
LEUKOENCEPHALOPATHY: BINSWANGER'S DISEASE. PECULIARITIES OF CURRENT AND TREATMENT
Abstract: The article describes the case of Binswanger's disease, developed relatively at a young age. The disease quickly progressed and ended in a fatal outcome. Neuroimaging and neuropsychological studies confirmed the diagnosis of leukoencephalopathy. Early diagnosis and adequate therapy will slow the progression of the disease.
Keywords: vascular dementia, atherosclerosis, lecoencephalopathy, Binswanger's disease, cognitive impairment.
To date, the diagnosis of Binswanger's disease is essentially a "rarity", is rarely established. Previously, such a diagnosis was established only pathoanatomi-cally, but modern methods of neuroimaging can diagnose this disease in vivo.
However, according to neuroimaging methods, most patients simultaneously have two or more pathogenetic types of vascular dementia.
Dermographic changes in the population structure of all developed countries led to a significant increase in the proportion of diseases of the elderly and especially chronic progressive cerebrovascular diseases (CEH). This raises the problem of chronic progressive disorders of cerebral circulation to one of the leading places in modern angioneurology.
Unlike acute disorders of cerebral circulation (CABG), the economic and medical consequences of chronic progressive disorders of cerebral circulation, are not exactly established. There is every reason to believe that they are very significant. Thus,
with the present trend towards the middle of this century, half of Europe's population will be over 60 years old. Since in this age group, the prevalence of dementia averages about 6%, and every 5 years this percentage is doubled, then 3-4% of the population will suffer from dementia.
The urgency of the problem is also due to social consequences. Neurological disorders and disorders of higher cortical functions in chronic progressive disorders of cerebral circulation can be the cause of severe disability of patients requiring significant financial costs for the maintenance of such patients, both from the relatives of the patient and the State. As a result of the expansion of the methodological possibilities for studying chronic progressive cerebral vascular diseases, a potential opportunity to prevent or slow the progression of cognitive impairment (CN), including dementia, under the condition of early diagnosis and timely pathogenetic treatment has arisen [Chui N., 2000; Bowler, J., 2002].
Currently, abroad, among progressive progressive disorders of cerebral circulation, isolated progressive vascular leukoencephalopathy (Binswanger's disease), also referred to as subcortical arteriosclerotic encephalopathy (SAE). In the domestic literature SAE is considered as one of the variants of discir-culatory encephalopathy in the presence of arterial hypertension (AH) [Shmidt E. V., Maksudov G. A., 1975; Shmidt E. V. 1985; Kalashnikova JI.A, et al., 1998; Shprakh V. V., 1994; Yakhno N. N., Damu-lin I. V., 1999].
Here is the case of leukoencephalopathy (Binswanger's disease), diagnosed in a middle-aged patient, with a subsequent fatal outcome.
The patient was born in 1967. He was born in the department of neurology with complaints from his relatives for a sharp decrease in his outlook, efficiency, lack of interest in others and difficulty walking due to frequent falls. Before the development of these conditions, the patient often complained of the occurrence of periodic headaches.
From the anamnesis it is revealed that the patient suffers for 4 years. Its disease does not connect with anything. At the beginning of the disease, the patient had headaches, dizziness, transient instability when walking. He noted an increase in irritation, sleep disturbance. Then, against the background of the symptoms of autonomic dystonia, there are impaired coordination - cerebellar ataxia, unsteady gait, increased dizziness. The patient underwent a number oflaboratory and instrumental studies, was treated with vasoactive drugs, after which the condition improved moderately. In 2016, the patient, against a backdrop of dizziness, developed stiffness of movements, disorientation in space and time, pseudobulbar syndrome. Since then, the patient described the symptoms have progressed. The patient entered the hospital due to deterioration of the state.
Neurological status: CHMN - smell, hearing preserved, II pair - visus OD = OS0,8, VII - symmetrical face, hypomimous, signs of central lesion of IX-X pair - nasal, periodic buries, XII - deviation
of tongue, dysarthria. The motor sphere - muscle tone increased by plastic type, muscle strength on both sides 3.5 points, reflexes brisk, pathological reflexes - upper Rossolimo, Babinsky, Marinescu-Rodovici, proboscis positive from both sides, walks with support. Sensitive sphere - sensitivity disorders could not be identified because of an inadequate state (we could not get a full answer to the questions asked). In the Romberg pose is unstable, the coordinating samples from both sides perform with mild ataxia, positive tests of Stuart-Holmes. Extrapyramidal system: oligobardikinesia, a positive symptom of the "cogwheel", hypomia, slowness of thinking. VNS - On examination, white dermographism, tachycardia, hyperhidrosis distal, significant weight loss are revealed. GNI is emotionally unstable, decreasing memory for current events, disrupting orientation in time and space, a significant decrease in intelligence, performing simple instructions, no more complex reactions, simpler answers to questions, more often using the words "yes", "no."
On MRI, according to literature data, more sensitive to changes in white matter, leukoareosis (LA) is a zone of altered signal intensity (decreased in T1 mode and increased in T2 and FLAIR regimes) localized in the periventricular and deep sections of the hemispheres, as well as in the the brain stem. The conducted studies showed that in the presence of LA on MRI in periventricular white matter a certain spectrum of pathomorphological changes is detected. This is mainly demyelination, gliosis, edema and degeneration of axons, expansion of perivascular spaces and the formation of cysts, extracellular and intracellular edema, heart attacks, angioectasias, Waller degeneration. These changes are very different in nature. The majority of the examined 54% showed a decrease in white matter density, especially expressed around the anterior (less often posterior) horns of the lateral ventricles (the phenomenon of "leukoareosis"), 32% - expansion of the ventricles of the brain and subatrophy of the cortex.
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It is believed that the expansion of perivascular spaces occurs with arterial hypertension as a result of pulsatile traumatisation of small vessels, which is accompanied by their elongation, crimp and atrophy of the adjacent parenchyma. The expansion of perivascular spaces and periventricular gliosis are less correlated with the severity of clinical manifestations than complete or incomplete infarctions, and neuroimaging methods in this zone usually reveal only a slight decrease in perfusion [Yakhno N. N., 2001, Pantoni L., 2010].
To determine the level of cognitive impairment, the patient was tested with MMSE, according to which a decrease in memory, attention, and violation of executive function was observed.
Patients were prescribed drugs to improve metabolism (citicolines, nootropics, neuroprotec-tors), vasoactive drugs, antiaggregants. Despite the treatment, the patient died 3 months after the examination and treatment.
Thus, the conducted observation showed that the course of Binswanger's disease (leukoencepha-
lopathy) can be malignant with a subsequent fatal outcome. The disease manifests itself by a rapid decrease in cognitive functions and the growth of organic lesions of the structures of the nervous system (affection of the coordinator, pyramidal and extrapyramidal systems). Instrumental methods of investigation confirmed the diagnosis. The treatment was not effective and the outcome was lethal. Systematizing the data of clinical-neurological,
electroencephalographs and neuroimaging studies, it can be said that the presence of focal neurological symptoms, changes in cognitive functions, disorganization or desynchronization of the main rhythms on the EEG in combination with morphostructural changes in the white matter of the brain allows the life diagnosis of Binswanger's disease to be in vivo in patients suffering from hypertensive disease.
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