A patient with long term severe hypeension develops progressive dementia. CT scan of the head demonstrates a diffuse loss of deep hemispheric white matter. Which of the following terms best describes the pathological process that is occurring?
This patient has subcoical leukoencephalopathy (Binswanger's disease), which is one of the neurologic syndromes associated with hypeension. It is uncommon, but obviously devastating. The histologic findings are diffuse, irregular loss of axons and myelin accompanied by widespread gliosis. Small infarcts may be seen in the frontal lobes. The pathologic mechanism may be damage caused by severe aeriosclerosis. None of the other choices would produce diffuse subcoical white matter involvement.Anemic infarcts can be seen in hypeensive patients as a consequence of atherosclerotic thromboembolic events. Hemorrhagic infarcts can also be seen in hypeensive patients as a consequence of atherosclerotic thromboembolic events followed by reperfusion. They tend to occur in gray matter or at the gray-white junction. Hypeensive encephalopathy is an acute generalized dysfunction of the brain that can occur in malignant hypeension or other very severe hypeensive processes. The primary pathology is seen in cerebral vessels, although cerebral edema may be present. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 34. Cerebrovascular Diseases. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.
Anemic infarcts
Hemorrhagic infarcts
Hypeensive encephalopathy
Subcoical leukoencephalopathy