Clinical manifestations and treatment of subcortical arteriosclerotic encephalopathy

Subcortical arteriosclemtic encephalopathy (SAE), also known as Binswanger's disease (BD) or chronic progressive subcortical encephalopathy, is an elderly cerebrovascular disease. What are its clinical manifestations?

【Clinical manifestations】

SAE is an important type of vascular dementia, with the onset age mostly ranging from 40 to 90 years old, and is most common after the age of 60. Hypertension, diabetes, cardiovascular disease, and frequent hypotension are the most common risk factors, and the medical history may include multiple minor strokes with diffuse neurological deficits. Vascular dementia accounts for 34% of all dementia patients in the United States; in Japan, it accounts for 53%, and SAE accounts for 35% of dementia patients. Tomonaga et al. reported that the incidence of SAE was 3.8%. The high incidence in Japan may be related to the fact that Japanese people suffer from more hypertension.

The clinical manifestations of SAE are diverse, which brings great difficulties to clinical diagnosis. They can be summarized into the following four aspects for easy clinical understanding.

1. Patients with a history of hypertension generally have a age of onset between 55 and 75 years old, with equal incidence in both sexes. Most patients have a history of one or more strokes and may have hemiplegia.

2. It develops in a chronic progressive process, usually taking 5 to 10 years. In a few cases, the disease may develop acutely, with a stable period or temporary improvement.

3. Gradually cumulative neurological signs of movement, sensation, vision, and reflex disorders usually coexist. There are often weakness of the pyramidal system, spasticity, hyperreflexia, pathological reflexes, etc. In the middle and late stages, clinical manifestations of pseudobulbar palsy and Parkinson's syndrome are particularly common.

4. Abnormal perception and behavior manifest as decreased movement. Loss of interest in surroundings, loss of will, reduced speech, and decreased comprehension, judgment, and calculation abilities. Memory and visual-spatial dysfunction.

【treat】

Currently, there is a lack of good treatment options for SAE. Since most scholars believe that the disease is related to hypertension, patients often suffer from stroke and dementia. Therefore, the principle of treatment is to first control high blood pressure, prevent stroke, prevent and treat arteriosclerosis, and treat dementia. Medication can be used to improve cerebral circulation, such as nimodipine, naotong, naoyiqin, and sibelium. Brain metabolism activators include citicoline, Nootropics, etc. In addition, hyperbaric oxygen chamber therapy can be tried.