Institute of Neuropathology, Fukushimura Hospital, Toyohashi, Japan.
Neuropathology. 2022 Oct;42(5):353-366. doi: 10.1111/neup.12785. Epub 2022 Apr 21.
In this paper, we have described the points to be noted when examining the macroscopic findings of the brain of patients with dementia. The characteristics of the macroscopic findings of the brain of patients with dementia are shown in the figure of the outer surface and the cut surface. Gross findings in the brain of patients with Alzheimer's disease should consider, in addition to the degree of limbic changes, whether the atrophy is diffuse, the degree of ventricular enlargement, and the complications of vascular changes. The macroscopic findings of the brain of patients with dementia with Lewy bodies are characterized by the absence of notable abnormal findings other than the depigmentation of the substantia nigra and locus coeruleus. In dementia with Lewy bodies, other types of dementia complications should be considered if abnormal findings are present. It should be noted that accurate diagnosis of argyrophilic grain dementia and senile dementia of neurofibrillary tangle type by macroscopic findings alone is often difficult to distinguish from a mild case of Alzheimer's disease and change by physiological aging in particular. In frontotemporal lobar degeneration, changes in the basal ganglia, brain stem, cerebellum and motor neurons should be observed to make a differential diagnosis of various types of frontotemporal lobar degeneration. It is important to understand the areas that are often damaged in different types of dementia and the extent of lesions, and to distinguish each type of dementia. Care should be taken as macroscopic findings are more complex when several types of dementia are mixed. It was shown that accurate understanding of macroscopic findings is essential for understanding clinical symptoms, imaging findings, differential diagnosis of dementia and disease pathogenesis.
在本文中，我们描述了检查痴呆患者大脑大体发现时需要注意的要点。痴呆患者大脑大体发现的特征显示在外表面和切面图中。阿尔茨海默病患者大脑的大体发现除了考虑边缘系统变化的程度外，还应考虑是否存在弥漫性萎缩、脑室扩大的程度以及血管变化的并发症。路易体痴呆患者大脑的大体发现的特征是除黑质和蓝斑色素脱失外，无明显异常发现。在路易体痴呆中，如果存在异常发现，应考虑其他类型的痴呆并发症。需要注意的是，仅凭大体发现准确诊断银染颗粒性痴呆和神经原纤维缠结型老年性痴呆，往往难以与轻度阿尔茨海默病以及特别是生理性老化引起的变化相区分。在额颞叶变性中，应观察基底节、脑干、小脑和运动神经元的变化，以对各种类型的额颞叶变性进行鉴别诊断。了解不同类型痴呆常受累的区域以及病变的程度，并对每种类型的痴呆进行区分是很重要的。当几种类型的痴呆混合时，大体发现更加复杂，需要特别注意。研究表明，准确理解大体发现对于理解临床症状、影像学发现、痴呆的鉴别诊断和疾病发病机制至关重要。
