Yong W H, Robert M E, Secor D L, Kleikamp T J, Vinters H V
Department of Pathology, UCLA School of Medicine 90024-1732.
Arch Neurol. 1992 Jan;49(1):51-8. doi: 10.1001/archneur.1992.00530250055016.
Clinical, radiological, and immunohistochemical findings in brain biopsy specimens from six patients with cerebral amyloid angiopathy-associated intracerebral hemorrhage were reviewed. Acute clinical presentations included headache, nausea and vomiting, loss of consciousness, and focal neurological deficits such as hemiplegia and blindness. Transient ischemic attacks experienced by one patient and referable to one hemisphere did not indicate impending hemorrhage in that region. Computed tomographic scans revealed acute, irregular, superficial, lobar hemorrhage with occasional ring enhancement. Immunohistochemical studies were performed on biopsy specimens using primary antibodies against portions of the Alzheimer A4 (beta-) peptide or gamma-trace peptide (the vascular amyloid protein in patients with hereditary cerebral hemorrhage with amyloidosis-Icelandic type). In all patients, anti-A4 and anti-gamma-trace labeled cerebral microvessels. Immunoreactive senile plaques were few compared with the numbers of stained microvessels. Reactive astrocytes in some patients were labeled by both antiserum samples, suggesting uptake or production of these proteins by the astrocytes. This study demonstrates the heterogeneous clinical and radiological features of cerebral amyloid angiopathy-related brain hemorrhage and the value of anti-A4 and anti-gamma-trace immunohistochemical study of biopsy material from patients with suspected cerebral amyloid angiopathy-related intraparenchymal bleeding.
回顾了6例脑淀粉样血管病相关性脑出血患者脑活检标本的临床、影像学和免疫组化结果。急性临床表现包括头痛、恶心、呕吐、意识丧失以及偏瘫和失明等局灶性神经功能缺损。1例患者出现的、可归因于一个半球的短暂性脑缺血发作并不提示该区域即将发生出血。计算机断层扫描显示急性、不规则、表浅的脑叶出血，偶尔有环形强化。使用针对阿尔茨海默A4（β-）肽或γ-微量蛋白（冰岛型遗传性脑出血伴淀粉样变性患者的血管淀粉样蛋白）部分的一抗对活检标本进行免疫组化研究。在所有患者中，抗A4和抗γ-微量蛋白标记了脑微血管。与染色微血管的数量相比，免疫反应性老年斑较少。一些患者的反应性星形胶质细胞被两种抗血清样本标记，提示星形胶质细胞摄取或产生了这些蛋白。本研究证明了脑淀粉样血管病相关性脑出血的临床和影像学特征的异质性，以及对疑似脑淀粉样血管病相关性脑实质内出血患者的活检材料进行抗A4和抗γ-微量蛋白免疫组化研究的价值。
