Tomonaga M, Yamanouchi H, Tohgi H, Kameyama M
J Am Geriatr Soc. 1982 Aug;30(8):524-9. doi: 10.1111/j.1532-5415.1982.tb01691.x.
A clinicopathologic study was made of 45 elderly persons whose autopsied brains showed the pathologic changes of progressive subcortical vascular encephalopathy (Binswanger type). Progressive subcortical vascular encephalopathy (PSVE) was observed in 3.8 per cent of all autopsied brains of elderly persons and in 6.7 per cent of the brains of those with cerebrovascular diseases. White matter lesions were graded from I to III (slight to severe). Small infarcts in the basal ganglia, thalamus, and pons were common, but the cerebral cortex was usually preserved. Neuropsychiatric symptoms included dementia, urinary incontinence, hemiplegia, pseudobulbar palsy, psychosis, parkinsonism, and mutism. In thge Grade III group there was a high incidence of pseudobulbar palsy, parkinsonism, and mutism. Pathologic study showed marked cerebral arteriosclerosis in almost all cases. Angionecrosis was observed in 60 to 80 per cent. Fibrotic and stenotic changes of the blood vessels in the deep white matter were also noted, particularly in 90 per cent of the Grade III cases. A suggested explanation for the pathogenesis of PSVE is based on the effects of various complications such as hypertension, cardiac disease and malnutrition which may play an important role in PSVE when they occur in elderly persons with a history of long-standing hypertension, marked cerebral arteriosclerosis, and arteriolar changes in the cerebral white matter.
对45例老年患者进行了临床病理研究，这些患者的尸检大脑显示出进行性皮质下血管性脑病（宾斯旺格型）的病理变化。在老年患者的所有尸检大脑中，进行性皮质下血管性脑病（PSVE）的发生率为3.8%，在患有脑血管疾病的患者大脑中发生率为6.7%。白质病变从I级到III级（轻度到重度）进行分级。基底节、丘脑和脑桥的小梗死很常见，但大脑皮质通常保留。神经精神症状包括痴呆、尿失禁、偏瘫、假性延髓麻痹、精神病、帕金森综合征和缄默症。在III级组中，假性延髓麻痹、帕金森综合征和缄默症的发生率很高。病理研究显示几乎所有病例都有明显的脑动脉硬化。60%至80%的病例观察到血管坏死。深部白质血管的纤维化和狭窄变化也很明显，特别是在III级病例的90%中。对PSVE发病机制的一种推测解释是基于各种并发症的影响，如高血压、心脏病和营养不良，当这些并发症发生在有长期高血压病史、明显脑动脉硬化和脑白质小动脉变化的老年人中时，可能在PSVE中起重要作用。
