Fact-sheet: Binswanger disease - small vessel dementia


Updated on 04/12/2026 at 5:59 PM

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Definition

Subcortical dementia of vascular origin, non-hereditary, with slow progression, secondary to Cerebral microangiopathy - cerebral small vessel disease with fibrohyaline thickening of the perforating cerebral microvessels responsible

  • for progressive vascular demyelination of the cerebral white matter,
  • and for lacunar infarcts of the deep gray nuclei, thalami, and pons.

It is the second leading cause of dementia in Europe and North America.

Clinical features

Cognitive impairment: slowly progressive subcortical dementia with mood disorders (depression) and personality changes

Headaches

Associated with chronic arterial hypertension and cardiovascular events.

Ultrasound

Doppler ultrasound: used for associated macrovascular workup

CT

Confluent periventricular hypodense areas, predominating in the frontal lobes and centra semiovale

Lacunes of the basal ganglia and thalami

MRI

Periventricular and deep white matter T2-FLAIR hyperintensities, giving an appearance of severe Cerebral microangiopathy - cerebral small vessel disease.

Sparing of the U-fibers

Frequent lacunes of the basal ganglia and thalami

Associated atherosclerosis of the basilar trunk and carotid siphons

Management

Control of cardiovascular risk factors

Classification

Fazekas score (or Fazekas and Schmidt scale): evaluates periventricular lesions and deep white matter lesions

  • Periventricular hyperintensities, grade: 0 = Absent
  • 1 = Linear or cap-like hyperintensity
  • 2 = Periventricular halo
  • 3 = Irregular periventricular hyperintensities extending into the deep white matter
  • Deep white matter hyperintensities, grade: 0 = Absent
  • 1 = Punctate hyperintensities
  • 2 = Beginning confluence of hyperintensities
  • 3 = Large confluent hyperintensities

Fazekas Classification MRI

Differential diagnosis

  • CADASIL - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy
  • Central nervous system vasculitis
  • Cerebral amyloid angiopathy
  • Alzheimer Disease