Kalashnikova L A, Gulevskaya T S, Dobrynina L A
Research Center of Neurology, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(2):90-99. doi: 10.17116/jnevro20181182190-99.
Cerebral microangiopathy (small vessels disease) is a cause of diffuse changes of brain tissue (encephalopathy) denoted in Russian literature by the term dyscirculatory encephalopathy (DE). The main cause of microangiopathy leading to encephalopathy is arterial hypertension, less frequently - cerebral amyloid angiopathy and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. The diagnosis of encephalopathy in patients with microangiopathy is based on the combination of clinical manifestations (mainly, cognitive impairment of varying severity and disorders of gait) with the neuroimaging changes (white matter hyperintensity, multiple lacunar infarcts on MRI). The causes of DE hyperdiagnosis in Russia, its differential diagnosis with the consequences of recurrent strokes as well as the question of the terminology are considered. The term 'microangioencephalopathy' (instead of DE) to denote encephalopathy in patients with the cerebral small vessel disease is proposed, as more fully reflecting morphological changes of the brain.
脑微血管病（小血管疾病）是脑组织弥漫性改变（脑病）的一个病因，在俄罗斯文献中用术语“血液循环障碍性脑病（DE）”来表示。导致脑病的微血管病的主要病因是动脉高血压，较少见的是脑淀粉样血管病和伴有皮质下梗死及白质脑病的脑常染色体显性动脉病。微血管病患者脑病的诊断基于临床表现（主要是不同程度的认知障碍和步态障碍）与神经影像学改变（白质高信号、MRI上的多发腔隙性梗死）的结合。文中探讨了俄罗斯DE过度诊断的原因、其与复发性中风后果的鉴别诊断以及术语问题。有人提议用“微血管性脑病”（而非DE）来表示脑小血管疾病患者的脑病，因为它能更全面地反映大脑的形态学变化。
