[Two clinical cases diagnosed provisionally as Binswanger type of vascular dementia--on possibility to its clinical recognition from neuropsychiatric findings and computed tomography (author's transl)].

The diagnosis of subcortical arteriosclerotic encephalopathy of Binswanger should be confirmed neuropathologically by postmortem examination. But we expect that it may be possible to diagnose provisionally as Binswanger's disease on the basis of clinical course and findings including computed tomography. Two cases, 57 years old postman (case 1) and 60 years old housewife (case 2) were reported. They had hypertension for over 20 years in their past history and showed a progressive dementia since before one year and 9 years. Transient syncopal attack and epileptiform seizure revealed occasionally. Psychiatrically either of them were apathetic, aspontaneous and autistic. One of them (case 2) showed a striking paranoid-hallucinatory state. Spastic gait disturbance and dysarthria are found neurologically, and moreover in case 1 revealed the incontinence of urine and feces. Arteriosclerotic changes were seen in the fundi. The EEG showed a slow alpha rhythm with scattered theta- and delta-waves. Laboratory data of blood, urine and CSF were normal. On the basis of these clinical course and findings the diagnosis of Binswanger's type of cerebral arteriosclerosis were suspected. The CT-scan of 2 cases proved a symmetrical enlargement of the lateral ventricles and marginated areas of definite abnormal low density in the white matter of the occipital (case 1) and frontal (case 1 and 2) lobes. Conclusively we may provisionally diagnosed our two cases as Binswanger's disease, also supported by the findings of CT.