In 1894 Otto Binswanger described a disease of the hemispheric white matter which he called 'encephalitis subcorticalis chronica progressiva'. He examined eight patients who had shown a slow but relentless cognitive decay that began in middle or old age and lead to severe dementia, characterized in the early stages by a disturbance of association of cortical sensory and motor areas, by aphasia, hemiamblyopia, hemianopia, hemiparesis and a loss of the sense of pressure, position and touch. At postmortem the patients showed white matter atrophy most pronounced in the temporal and occipital lobes. Binswanger proposed that this subcortical fibre loss was due to cerebral arteriosclerosis, which was almost invariably demonstrated. 'Binswanger's disease' has gained topical importance following the introduction of sensitive imaging techniques which have led to the frequent detection of white matter disease during life. This full account of his original observations may contribute to the clarification of contemporary terminological issues.
KEY wows-Binswanger's disease, subcortical encephalitis, vascular dementia, multi-infarct dementia, neurosyphilis, history of psychiatry, history of neurology.