以脑梗死为首发症状的脑血管淀粉样变性1例
李青云,来青伟,李昕昱,袁蕊,胡朋,樊红彬
摘要(Abstract)：
<正>脑血管淀粉样变性(cerebral amyloid angiopathy,CAA)是一种常见的小血管疾病,主要由于β样淀粉蛋白沉积在血管壁内造成,是颅内自发性出血的主要原因[1]。除出血性脑损伤以外,CAA也和广泛的脑缺血损伤有关[2,3]。本文报道1例以脑梗死为首发症状的CAA患者,并结合文献进行复习。1临床资料患者,男,64岁,因"突发右侧肢体麻木无力伴有言语不清1 d"于2015年8月2日入院,患者既往体健,无原发性高血压、糖尿病、心脏病史。体格检查:体温36.2℃,心率70次/分,血压135/80 mm Hg(1 mm Hg=0.133 k Pa),心肺腹检查未见异常。神
关键词(KeyWords)： 脑血管淀粉样变性;脑梗死;脑出血;抗栓治疗
基金项目(Foundation):
作者(Author): 李青云,来青伟,李昕昱,袁蕊,胡朋,樊红彬
DOI: 10.16780/j.cnki.sjssgncj.2016.05.030
参考文献(References)：
- [1]Finelli PF,Kessimian N,Bernstein PW.Cerebral amyloid angiopathy manifesting as recurrent intracerebral hemorrhage[J].Arch Neurol,1984,41:330-333.
- [2]Gurol ME,Viswanathan A,Gidicsin C,et al.Cerebral amyloid angiopathy burden associated with leukoaraiosis:a positron emission tomography/magnetic resonance imaging study[J].Ann Neurol,2013,73:529-536.
- [3]K?vari E,Herrmann FR,Hof PR,et al.The relationship between cerebral amyloid angiopathy and cortical microinfarcts in brain ageing and Alzheimer's disease[J].Neuropathol Appl Neurobiol,2013,39:498-509.
- [4]Jellinger KA.Vascular-ischemic dementia:an update[M].Springer Vienna,2002.
- [5]Yamaguchi H,Yamazaki T,Lemere CA,et al.Beta amyloid is focally deposited within the outer basement membrane in the amyloid angiopathy of Alzheimer's disease.An immunoelectron microscopic study[J].Am JPathol,1992,141:249-259.
- [6]曾玮,胡全忠.脑血管淀粉样变[J].世界最新医学信息文摘(电子版),2015,15:19-22.
- [7]Pezzini A,Del Zotto E,Volonghi I,et al.Cerebral amyloid angiopathy:a common cause of cerebral hemorrhage[J].Curr Med Chem,2009,16:2498-2513.
- [8]Passero S,Burgalassi L,D’Andrea P,et al.Recurrence of bleeding in patients with primary intracerebral hemorrhage[J].Stroke,1995,26:1189-1192.
- [9]Charidimou A,Gang Q,Werring DJ.Sporadic cerebral amyloid angiopathy revisited:recent insights into pathophysiology and clinical spectrum[J].J Neurol Neurosurg Psychiatry,2012,83:124-137.
- [10]Charidimou A,Peeters A,Fox Z,et al.Spectrum of transient focal neurological episodes in cerebral amyloid angiopathy multicentre magnetic resonance imaging cohort study and meta-analysis[J].Stroke,2012,43:2324-2330.
- [11]Wardlaw JM,Smith EE,Biessels GJ,et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J].Lancet Neurol,2013,12:822-838.
- [12]Chen YW,Gurol ME,Rosand J,et al.Progression of white matter lesions and hemorrhages in cerebral amyloid angiopathy[J].Neurology,2006,67:83-87.
- [13]Gregoire SM,Charidimou A,Gadapa N,et al.Acute ischaemic brain lesions in intracerebral haemorrhage:multicentre cross-sectional magnetic resonance imaging study[J].Brain,2011,134:2376-2386.
- [14]Milner E,Zhou ML,Johnson AW,et al.Cerebral Amyloid Angiopathy Increases Susceptibility to Infarction After Focal Cerebral Ischemia in Tg2576 Mice[J].Stroke,2014,45:3064-3069.
- [15]Hartz AMS,Bauer B,Soldner ELB,et al.Amyloid-βcontributes to blood-brain barrier leakage in transgenic human amyloid precursor protein mice and in humans with cerebral amyloid angiopathy[J].Stroke,2012,43:514-523.
- [16]Menon RS,Kidwell CS.Neuroimaging demonstration of evolving small vessel ischemic injury in cerebral amyloid angiopathy[J].Stroke,2009,40:e675-e677.
- [17]Schrag M,Mc Auley G,Pomakian J,et al.Correlation of hypointensities in susceptibility-weighted images to tissue histology in dementia patients with cerebral amyloid angiopathy:a postmortem MRI study[J].Acta Neuropathol,2010,119:291-302.
- [18]Knudsen KA,Rosand J,Karluk D,et al.Clinical diagnosis of cerebral amyloid angiopathy:validation of the Boston criteria[J].Neurology,2001,56:537-539.
- [19]Vernooij MW,van der Lugt A,Ikram MA,et al.Prevalence and risk factors of cerebral microbleeds The Rotterdam Scan Study[J].Neurology,2008,70:1208-1214.
- [20]Biffi A,Halpin A,Towfighi A,et al.Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy[J].Neurology,2010,75:693-698.
- [21]Gregoire SM,J?ger HR,Yousry TA,et al.Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage:hospital-based,case-control study[J].J Neurol Neurosurg Psychiatry,2010,81:679-684.