Puy Laurent, Rauch Antoine, Deramecourt Vincent, Cordonnier Charlotte, Bérézowski Vincent
Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).
Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France (A.R.).
Stroke. 2023 Mar;54(3):e58-e62. doi: 10.1161/STROKEAHA.122.040908. Epub 2023 Feb 13.
To further our understanding of the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and related injury, we provided a postmortem neuropathological examination of acute microvascular lesions (microbleeds and microinfarcts) within the perihematomal area.
We included all consecutive cases (2005-2019) from the Lille University Hospital brain bank of ICH patients who died within the first month. Paraffin-embedded tissue sections from the perihematomal area were processed for several stainings and immunolabelings to investigate the presence of acute microbleeds and microinfarcts in the perihematomal area and to characterize surrounding neuronal and systemic inflammatory reaction (macrophages and neutrophils).
We included 14 ICH cases (median age, 78 years; 10 females). Acute microbleeds were observed in the perihematomal area in 12/14 patients (86%, ranging from 1 through >10) and microinfarcts in 5/14 (36%, ranging from 1 through 4). Microbleeds were observed whatever the delay from ICH onset to death was, while most cases with acute microinfarcts were observed between day 3 and day 7 (n=3/5). Both lesions were characterized by an abundant accumulation of systemic inflammatory cells and necrotic areas.
Acute microbleeds and microinfarcts might contribute to the propagation of secondary brain tissue damages after ICH. Our examinations also question the potential role of massive systemic inflammatory cells recruitment in the genesis of these microvascular injuries.
为了进一步了解自发性脑出血（ICH）的病理生理学及相关损伤，我们对血肿周围区域的急性微血管病变（微出血和微梗死）进行了尸检神经病理学检查。
我们纳入了里尔大学医院脑库中2005年至2019年间所有在发病后第一个月内死亡的ICH患者的连续病例。对血肿周围区域的石蜡包埋组织切片进行多种染色和免疫标记，以研究血肿周围区域急性微出血和微梗死的存在情况，并对周围神经元和全身炎症反应（巨噬细胞和中性粒细胞）进行特征描述。
我们纳入了14例ICH病例（中位年龄78岁；10名女性）。14例患者中有12例（86%，范围为1至>10个）在血肿周围区域观察到急性微出血，5例（36%，范围为1至4个）观察到微梗死。无论从ICH发病到死亡的时间间隔如何，均观察到微出血，而大多数急性微梗死病例在第3天至第7天之间观察到（n = 3/5）。两种病变均以全身炎症细胞大量积聚和坏死区域为特征。
急性微出血和微梗死可能导致ICH后脑组织继发性损伤的扩散。我们的检查还对大量全身炎症细胞募集在这些微血管损伤发生中的潜在作用提出了质疑。
