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由脑水肿导致的脱髓鞘疾病?

Demyelinating diseases as a result of cerebral edema?

作者信息

Barz Helmut, Schreiber Almut, Barz Ulrich

机构信息

Holunderweg 17, D-18209 Bad Doberan, Germany; Department of Neuropathology, Dietrich-Bonhoeffer Hospital, D-17022 Neubrandenburg, PF 400135 Mecklenburg-West-Pomerania, Germany.

Fit for work, Bautzener Landstraβe 91, D-01324 Dresden, Saxony, Germany.

出版信息

Med Hypotheses. 2017 Jul;104:10-14. doi: 10.1016/j.mehy.2017.05.010. Epub 2017 May 10.

Abstract

Due to the elastic properties of the human organs, tissue edema causes an increased tissue pressure. This phenomenon leads to a reduction of blood circulation or ischemia, and thus leads to the hypothesis that tissue edema can be the cause of demyelinating lesions. Even though brain edema occurs in the whole brain, the authors assume that the characteristically focal appearance of demyelinated lesions, for instance of multiple sclerosis plaques, are attributable to anatomical and structural characteristics of the brain. In an experimental section, a balloon inserted into the brain and other organs removed during autopsies produces an increased tissue pressure. This model shows tissue pressure in the vicinity of the balloon up to 80mmHg. The height of the produced pressure varies in different organs and special regions of the brain. The verified pressures in the pons cerebri show that stretched myelinated fiber bundles in outer regions can induce strong pressures in enclosed edematous tissue, as seen in central pontine myelinolysis. The presented experimental results support the hypothesis that demyelinated lesions, as seen in multiple sclerosis, may be caused by increased tissue pressure, or respectively, brain edema.

摘要

由于人体器官的弹性特性,组织水肿会导致组织压力升高。这种现象会导致血液循环减少或局部缺血,从而引出组织水肿可能是脱髓鞘病变原因的假说。尽管脑水肿发生在整个大脑,但作者认为脱髓鞘病变典型的局灶性表现,比如多发性硬化斑块,可归因于大脑的解剖和结构特征。在实验部分,将一个气球插入大脑以及在尸检时移除其他器官会导致组织压力升高。该模型显示气球附近的组织压力高达80mmHg。所产生压力的大小在不同器官和大脑的特殊区域有所不同。脑桥中经证实的压力表明,如在渗透性脱髓鞘综合征中所见,外部区域拉伸的有髓纤维束可在封闭的水肿组织中诱导强大压力。所呈现的实验结果支持这样的假说,即多发性硬化中所见的脱髓鞘病变可能是由组织压力升高或脑水肿分别引起的。

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