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为探讨淀粉样脑血管病相关脑出血(CAAH)的临床和病理特点,对5例高血压性脑出血而尸检证实为CAAH患者的临床表现、神经影像学和脑组织局部解剖进行了研究。结果表明,典型CAAH的神经影像学改变以皮质、皮质下脑叶出血多见,血肿形态多不规则,占位效应明显。但常见的高血压脑出血部位,并不能排除CAAH的可能。HE染色可见淀粉样蛋白沉积,正常血管壁由透明样嗜伊红样物替代。刚果红染色阳性。可见程度不等的血管壁淀粉样蛋白浸润、内膜消失,较大血管呈透明样、非淀粉样透明样变性,主要是脑膜和皮质的中小动脉受累,以血管壁淀粉样蛋白浸润和内膜消失等改变最常见。受累血管主要是脑膜和皮质的中、小动脉。结论:CAAH的发病情况和临床表现类似于高血压性脑出血。CAAH可由慢性血管病变所致,高血压可加重此种改变。胶质纤维酸性蛋白(GFAP)阳性染色表明存在继发性缺血性脑损伤。
To investigate the clinical and pathological features of cerebral hemorrhage associated with amyloid cerebrovascular disease (CAAH), five patients with hypertensive intracerebral hemorrhage were confirmed by autopsy as the clinical manifestations, neuroimaging and brain anatomy of patients with CAAH. The results showed that the typical CAAH neuroimaging cortical, subcortical lobar hemorrhage more common, more irregular shape of hematoma, mass effect is obvious. However, common hypertensive intracerebral hemorrhage site, and can not rule out the possibility of CAAH. Amyloid deposition was visible by HE staining and the normal vessel wall was replaced by a clear, eosinophilic sample. Congo red staining positive. Visible varying degrees of vascular wall amyloid infiltration, disappearance of the intima, larger vessels were transparent, non-amyloid-like degeneration, mainly meningeal and cortical arterioles involved, to the vascular wall amyloid infiltration and intima Variations such as disappearances are most common. Affected vessels are mainly meninges and cortex in the small artery. Conclusion: The incidence and clinical manifestations of CAAH are similar to hypertensive intracerebral hemorrhage. CAAH can be caused by chronic vascular disease, which can be exacerbated by hypertension. Positive glial fibrillary acidic protein (GFAP) staining indicates the presence of secondary ischemic brain damage.