Takayama Mio, Kashiwagi Masayuki, Hara Kenji, Matsusue Aya, Waters Brian, Ikematsu Natsuki, Kubo Shin-Ichi
Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Neuropathology. 2017 Oct;37(5):441-445. doi: 10.1111/neup.12383. Epub 2017 Apr 10.
A man in his late forties had lived as a recluse for more than ten years. He was found dead in his room. At autopsy, subarachnoid hemorrhage (SAH) was detected at the base of the brain, which weighed 1333 g. The cerebellar tonsil was swollen. The cerebral ventricle was enlarged and filled with blood. A hematoma was observed in the upper part of the left side of the cerebellar hemisphere. The location and size of SAH in this case indicated that the rupture of a cerebral aneurysm (CA) had occurred; however, CA was not detected. A mass of blood vessels buried in the hematoma was observed at the left cerebellopontine angle (CPA). The vascular lesion showed round-shaped blood vessels as well as flat-shaped vessels with the appearance of veins, but with elastic fibers indicative of arteries. The lesion was considered to be the nidus and was 5-8 mm in size. Feeding arteries appeared to be from the anterior inferior cerebellar artery (AICA). However, the draining vein and anastomotic parts of the artery and vein were not confirmed. Based on these histopathological features, this vascular lesion was diagnosed as arteriovenous malformation (AVM). A differential diagnosis between AVM at CPA and CA is needed in order to identify the source of non-traumatic SAH.
一名四十多岁的男子隐居了十多年。他被发现死在自己的房间里。尸检时，在脑底部发现蛛网膜下腔出血（SAH），脑重1333克。小脑扁桃体肿胀。脑室扩大并充满血液。在小脑半球左侧上部观察到一个血肿。该病例中SAH的位置和大小表明发生了脑动脉瘤（CA）破裂；然而，未检测到CA。在左小脑脑桥角（CPA）的血肿中观察到一团埋在其中的血管。血管病变显示有圆形血管以及呈静脉外观的扁平血管，但有表明动脉的弹性纤维。该病变被认为是病灶，大小为5 - 8毫米。供血动脉似乎来自小脑下前动脉（AICA）。然而，引流静脉以及动静脉吻合部位未得到证实。基于这些组织病理学特征，该血管病变被诊断为动静脉畸形（AVM）。为了确定非创伤性SAH的来源，需要对CPA处的AVM和CA进行鉴别诊断。
