Ｂｉｎｓｗａｎｇｅｒ型白質脳症の眼球運動障害について

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  • Impairment of eye movements in Binswanger's encephalopathy

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Binswanger's encephalopathy is a form of vascular dementia characterized by extensive degeneration of the cerebral white matter and multiple lacunar infarcts. Extensive damage to the white matter causes disruption of both the Cortico-cortical and Cortico-subcortical neural networks, resulting in the so-called disconnection syndrome. As white matter lesions are particularly prominent in the frontal lobe, abnormal eye movements may result from impairment of pathways between the frontal eye fields and other cortical eye fields, as well as the basal ganglia, brain stem, and cerebellum. In the present study, we evaluated eye movements in three patients with Binswanger's encephalopathy using electronystagmography. No clear limited range of eye movements or gaze-evoked nystagmus was observed in any of the patients. Mild impairment of pursuit was seen in all patients. As for saccades, all patients had mild hypometria and slow vertical saccades, while two also had slow horizontal saccades. In addition, saccade latency was prolonged horizontally and vertically in two patients. Decrease in the slow phase of optokinetic nystagmus (OKN) was also observed in all patients, but the decrease was significant in only one patient. No impairment of visual suppression (VS) was seen. Few studies have investigated impairment of eye movements in Binswanger's encephalopathy. The present study showed characteristic abnormal eye movements in the patients, relatively mild impairment of pursuit, saccade and OKN, and slow saccades, but no impairment of VS. These findings were different from eye movement abnormalities caused by cerebellar, brain stem lesions or cortical dementia.

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