Chen Chuang-Sin, Lo Yuk-Keung, Yan Sui-Hing, Lin Yuh-Te, Lai Ping-Hong, Lo Yu-Shing
Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan.
Acta Neurol Taiwan. 2004 Mar;13(1):14-9.
Cerebral amyloid angiopathy (CAA) contributes to sporadic lobar intracerebral hemorrhage in older patients, especially those who are more than 70 years old. In clinical practice, a diagnosis of CAA refers to the Boston Criteria, which requires that "definitive" cases be confirmed by pathologic evidence at autopsy. A "Probable" case, means that there is clinical support and that pathologic evidence is available by biopsy from the craniotomy for patients with severe lobar intracerebral hemorrhage. Cerebral amyloid that is deposited in cortical vessels is revealed by apple-green birefringence under polarized light using Congo-red stain. Rebleeding after a first primary intracerebral hemorrhage is common. This paper describes five cases of aged patients with lobar cerebral hemorrhage and craniotomy with hematoma evacuation and biopsy. Pathological results all showed amyloid angiopathy. Various outcomes are discussed, and the literature is reviewed. Findings show that although patients with CAA were at high risk of recurrent hemorrhage after surgery, the mortality rate was relatively low despite the severity of lobar intracerebral hemorrhage.
脑淀粉样血管病（CAA）是老年患者散发性脑叶脑出血的病因之一，尤其是70岁以上的患者。在临床实践中，CAA的诊断参照波士顿标准，该标准要求“确诊”病例需经尸检病理证据证实。“疑似”病例是指有临床支持且对于重度脑叶脑出血患者可通过开颅活检获得病理证据。使用刚果红染色，在偏振光下可见沉积于皮质血管的脑淀粉样物质呈现苹果绿色双折射。首次原发性脑出血后再出血很常见。本文描述了5例老年脑叶脑出血患者行开颅血肿清除术及活检的情况。病理结果均显示为淀粉样血管病。文中讨论了各种转归并回顾了相关文献。研究结果表明，尽管CAA患者术后再出血风险较高，但尽管脑叶脑出血严重，死亡率相对较低。
