脑淀粉样血管病中的可逆性脑室周围高信号病变：一例拟似脑淀粉样血管病相关性炎症的病例。

Reversible Periventricular Hyperintensity Lesions in Cerebral Amyloid Angiopathy: A Case Mimicking Cerebral Amyloid Angiopathy-related Inflammation.

机构信息

Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan.

Department of Neurology, Saiseikai Kumamoto Hospital, Japan.

出版信息

Intern Med. 2022 Dec 1;61(23):3581-3584. doi: 10.2169/internalmedicine.8630-21. Epub 2022 May 14.

DOI:10.2169/internalmedicine.8630-21

PMID:35569976

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9790795/

Abstract

A 59-year-old man with progressive cognitive decline and mood disturbances was admitted to the hospital. Brain magnetic resonance imaging revealed marked white matter hyperintensity (WMH) and widespread lobar cerebral microbleeds. Because he had untreated hypertension, we started antihypertensive treatment and found a significantly improved cognitive function and WMH regression. We diagnosed him with cerebral amyloid angiopathy (CAA) based on the modified Boston Criteria with the rare apolipoprotein E (ApoE) ε2/ε4 genotype. The mechanism underlying reversible leukoencephalopathy in CAA may be related to the loss of autoregulation of brain circulation: cerebrovascular amyloid β deposits damaged the blood-brain barrier of the capillaries, which led to vasogenic edema induced by blood pressure surges.

摘要

一位 59 岁男性，逐渐出现认知功能减退和情绪障碍，被收入院。脑部磁共振成像显示明显的脑白质高信号（WMH）和广泛的脑叶性微出血。由于他患有未经治疗的高血压，我们开始进行降压治疗，发现认知功能显著改善，WMH 也有所消退。我们根据改良的波士顿标准和罕见的载脂蛋白 E（ApoE）ε2/ε4 基因型，诊断他患有脑淀粉样血管病（CAA）。CAA 中可逆性脑白质病的机制可能与脑循环自动调节丧失有关：脑血管淀粉样 β 沉积破坏了毛细血管的血脑屏障，导致血压骤升引起的血管源性水肿。