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两例脑活检后出现白质病变且未经免疫治疗病情好转的脑淀粉样血管病病例

[Two cases of cerebral amyloid angiopathy in which white matter lesions appearing after brain biopsy got improvement without immunotherapy].

作者信息

Asano Kohei, Hosoyama Sachiko, Takeuchi Yuko

机构信息

Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital.

Department of Neurology, Nagoya Ekisaikai Hospital.

出版信息

Rinsho Shinkeigaku. 2024 Jan 20;64(1):23-27. doi: 10.5692/clinicalneurol.cn-001887. Epub 2023 Dec 8.

Abstract

The first case was a 75-year-old woman with intermittent sensory impairment of the left hand. FLAIR of the head MRI revealed hyperintensity along the pia mater in the right parieto-temporal lobe with few microbleeds. Our second case was a 78-year-old man who presented with motor aphasia. His MRI showed swollen cortex on FLAIR and cortical hemosiderosis on T* weighted imaging of the right cerebral hemisphere. Pathological findings indicated the first case as cerebral amyloid angiopathy (CAA)-related inflammation and the second case as CAA. Additionally, after brain biopsy, widespread white matter lesions were detected in the area surrounding the biopsy site. However, both patients showed improvement without immunotherapy. Therefore, it is important to consider whether immunotherapy is required when white matter lesions appear in the area surrounding the biopsy site.

摘要

第一例是一位75岁的女性,有左手间歇性感觉障碍。头部MRI的液体衰减反转恢复序列(FLAIR)显示右侧顶颞叶沿软脑膜有高信号,伴有少量微出血。我们的第二例是一位78岁的男性,表现为运动性失语。他的MRI在FLAIR序列上显示皮质肿胀,在右侧大脑半球的T*加权成像上显示皮质含铁血黄素沉着。病理结果表明第一例为脑淀粉样血管病(CAA)相关炎症,第二例为CAA。此外,脑活检后,在活检部位周围区域检测到广泛的白质病变。然而,两名患者未经免疫治疗均有改善。因此,当活检部位周围区域出现白质病变时,考虑是否需要免疫治疗很重要。

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