Mehdorn H M, Gerhard L, Müller S P, Olbrich H M
Dept of Neurosurgery, University of Essen Medical Center, Fed. Rep. of Germany.
Neurosurg Rev. 1992;15(2):111-6. doi: 10.1007/BF00313505.
Spontaneous intracerebral hemorrhages can occur in patients with severe amyloid angiopathy and other morphological signs of Alzheimer's disease (AD). We observed 15 patients in whom histological examination of brain tissue specimens obtained at surgery revealed characteristic congophilic amyloid deposits in subcortical arteries and/or nerve cells. Clinical follow-up examinations were carried out up to 9 years after diagnosis. In addition, three survivors from the operated group were investigated by neuropsychological testing and single photon emission computer tomography (SPECT) using Tc-99m-HMPAO for determination of regional cerebral blood flow (rCBF). SPECT could not differentiate between the "typical Alzheimer disease pattern" of bilateral temporo-parietal rCBF reduction and flow deficits resulting from previous hemorrhage. Intellectual functioning was found to be impaired to various degrees ranging from normal function to severe dementia (MMS test scores varied between 15 and 26 points); again, it was difficult to differentiate clinically between the nosologic entities mentioned above. On the basis of our present experience we cannot distinguish between brain dysfunction due to Alzheimer's disease and intracranial hemorrhage from amyloid angiopathy. This supports the idea that intracranial hemorrhage may only be one clinical manifestation of amyloid deposits, another one being "Alzheimer's disease" with varying preponderance.
自发性脑出血可发生于患有严重淀粉样血管病及其他阿尔茨海默病（AD）形态学特征的患者。我们观察了15例患者，手术获取的脑组织标本组织学检查显示皮质下动脉和/或神经细胞中有特征性嗜刚果红淀粉样沉积物。诊断后进行了长达9年的临床随访检查。此外，对手术组的3名幸存者进行了神经心理学测试和使用锝-99m-六甲基丙烯胺肟（Tc-99m-HMPAO）的单光子发射计算机断层扫描（SPECT），以测定局部脑血流量（rCBF）。SPECT无法区分双侧颞顶叶rCBF降低的“典型阿尔茨海默病模式”和既往出血导致的血流缺损。发现智力功能存在不同程度的损害，从正常功能到严重痴呆（简易精神状态检查表（MMS）测试分数在15至26分之间变化）；同样，临床上也很难区分上述疾病实体。根据我们目前的经验，我们无法区分阿尔茨海默病导致的脑功能障碍和淀粉样血管病引起的颅内出血。这支持了颅内出血可能只是淀粉样沉积物的一种临床表现的观点，另一种表现是占比不同的“阿尔茨海默病”。
