Pullicino P, Ostrow P, Miller L, Snyder W, Munschauer F
Department of Neurology, State University of New York at Buffalo, USA.
Ann Neurol. 1995 Apr;37(4):460-6. doi: 10.1002/ana.410370408.
To investigate apparently asymptomatic, bilateral symmetrical predominantly pontine hyperintensities (PHI) on magnetic resonance imaging (MRI) scans in elderly patients, we examined the pons histopathologically in two brains of elderly hypertensives with PHI, and in three without PHI, on postmortem MRI scans. We also reviewed 85 serial in vivo MRI scans of patients over 60 and compared scan findings, vascular risk factors, and clinical symptoms between patients with PHI and a control group. A subcortical arteriosclerotic encephalopathy (SAE)-like pathology was present in the pons in only the two autopsy brains with PHI and corresponded with the location of PHI on the postmortem MRI scans and with the most frequent sites of PHI on in vivo scans. SAE also involved the hemispheric white matter in one of the autopsy brains. Five of 16 (31%) patients with, and 4 of 69 (6%) without, PHI on in vivo MRI scans had marked periventricular hyperintensity (PVHI) compatible with SAE (p = 0.01). We conclude that an SAE-like pathology may be seen in the pons in elderly hypertensives and this pathology is probably the cause of PHI seen on MRI scans of patients over 60 years of age.
为了研究老年患者磁共振成像（MRI）扫描中明显无症状的双侧对称性主要累及脑桥的高信号（PHI），我们对两例有PHI的老年高血压患者及三例无PHI的老年高血压患者的脑桥进行了尸检MRI扫描后的组织病理学检查。我们还回顾了85例60岁以上患者的系列活体MRI扫描，并比较了有PHI患者与对照组之间的扫描结果、血管危险因素及临床症状。仅在两例有PHI的尸检脑桥中存在皮质下动脉硬化性脑病（SAE）样病理改变，且与尸检MRI扫描上PHI的位置以及活体扫描上PHI最常见的部位相符。在其中一例尸检脑中，SAE还累及了半球白质。在活体MRI扫描中有PHI的16例患者中有5例（31%），无PHI的69例患者中有4例（6%）有与SAE相符的明显脑室周围高信号（PVHI）（p = 0.01）。我们得出结论，老年高血压患者的脑桥中可能会出现SAE样病理改变，且这种病理改变可能是60岁以上患者MRI扫描中所见PHI的原因。
