Ujihira N, Hashizume Y, Takahashi A
Department of Neurology, Nagoya University School of Medicine, Japan.
Nagoya J Med Sci. 1993 Nov;56(1-4):89-99.
A clinico-neuropathological study was conducted on 60 cases of brain death, 36 males and 24 females, ranging in age from 11 to 81 years, the average being 49.4 years. Of these, 29 patients died of cerebrovascular disease. The average duration of brain death was 99 hours. The mean weight of the brain was 1466 g. Neuropathological findings were brain edema, congestion, herniation and various subarachnoid hemorrhages. Histologically, the cytoplasm of neurons was pale and ghost-like. In the white matter, myelin staining was pale, and nuclei of the glial cells were shrunken and piknotic. Autolysis of the cerebellar granular layer and the pituitary gland was evident in all cases. No reactive astrocytosis or infiltration of the cells in or around necrotic tissue could be seen. In eight cases, there was laminar infiltration of neutrophils in the superficial area of the cerebrum and brain stem, possibly due to temporary or partial recirculation. Correlation between the degree of autolysis and duration of brain death was observed, but no relationship between the degree of autolysis and the difference of underlying disease could be found. Autolysis in the cerebral cortex, thalamus, tegmentum of the brain stem, cerebellar granular layer and pituitary gland was most prominent. However, neuropathological diagnosis of underlying diseases could be made even in brain death. Histologically, the cases of brain death differed from those of cardiac arrest-induced encephalopathy and from those of long postmortem autopsy.
对60例脑死亡病例进行了临床神经病理学研究，其中男性36例，女性24例，年龄在11岁至81岁之间，平均年龄为49.4岁。其中，29例患者死于脑血管疾病。脑死亡的平均持续时间为99小时。脑的平均重量为1466克。神经病理学发现包括脑水肿、充血、脑疝和各种蛛网膜下腔出血。组织学上，神经元的细胞质苍白如幽灵状。在白质中，髓鞘染色变淡，神经胶质细胞的细胞核萎缩并固缩。所有病例中均可见小脑颗粒层和垂体的自溶现象。在坏死组织内或周围未见反应性星形细胞增生或细胞浸润。8例患者在大脑和脑干表面区域有中性粒细胞层状浸润，可能是由于暂时或部分再循环所致。观察到自溶程度与脑死亡持续时间之间存在相关性，但未发现自溶程度与潜在疾病差异之间的关系。大脑皮质、丘脑、脑干被盖、小脑颗粒层和垂体的自溶最为明显。然而，即使在脑死亡病例中也可对潜在疾病进行神经病理学诊断。组织学上，脑死亡病例与心脏骤停所致脑病病例以及长期死后尸检病例不同。
