Binswanger’s disease: The first report in Thailand and review of the literature.

ABSTRACT

The first Binswanger’s Disease in Thailand was documented. He was a 87 year old doctor having the trouble of tremor, difficulty in walking, memory loss and behavioural change for 1 year. He had been suffering from hypertension and ischaemic heart disease for 4 years. Recently his relative noticed that he had needed regular attendant to cope with his normal daily living. He could not control his bladder and bowel openings as well as confusion at night time with some hallucination. Examination revealed sthenic build, alert, but marked memory deficit. He could not calculate the simple subtraction of seven from 100, proverb interpretation, and abstract thinking in spite of his clear understanding and no speech trouble. Neurological examination showed generalized rigidity of muscle and hand tremor. Deep tendon reflexes were exaggerated with bilateral Babinski signs. Computed brain scan revealed diffuse brain atrophy with periventricular and centrum semiovale low density areas. The ventricles were enlarged as well as widened sulci. The patient was admitted for 18 days with symptomatic treatment. The up to date literature on Binswanger’s disease is reviewed in this report.