Itoh Y, Yamada M, Hayakawa M, Otomo E, Miyatake T
Department of Internal Medicine, Yokufukai Geriatric Hospital, Tokyo, Japan.
J Neurol Sci. 1993 Jun;116(2):135-41. doi: 10.1016/0022-510x(93)90317-r.
We investigated consecutive 1000 autopsied cases (average age 82.9 years) clinicopathologically in order to reveal the significance of cerebral amyloid angiopathy (CAA) as a cause of senile intracranial hemorrhages. We found 101 cases with intracerebral hemorrhages, and CAA accounted for 10.9% of them (31.0% of lobar cerebral hemorrhages, and 14.3% of cerebellar ones). In contrast to hypertensive hemorrhages, CAA-related ones (1) ruptured into the subarachnoid space without exception, (2) often coexisted with dementia of Alzheimer's type, and (3) frequently occurred in the night without elevated blood pressure at onset. The cerebrovascular amyloid was strongly immunoreactive with antibody to beta-protein in all of the cases with CAA-related hemorrhages, and less intensively with antibody to cystatin C in 91% of them. Our data indicate that CAA is an important etiological factor of cerebellar hemorrhages, as well as lobar cerebral hemorrhages, in normotensive, aged patients.
我们对连续1000例尸检病例（平均年龄82.9岁）进行了临床病理研究，以揭示脑淀粉样血管病（CAA）作为老年颅内出血病因的意义。我们发现101例脑内出血病例，其中CAA占10.9%（脑叶脑出血的31.0%，小脑脑出血的14.3%）。与高血压性脑出血不同，CAA相关的脑出血（1）无一例外地破入蛛网膜下腔，（2）常与阿尔茨海默型痴呆共存，（3）常在夜间发生，发病时血压不升高。在所有CAA相关脑出血病例中，脑血管淀粉样蛋白与β蛋白抗体呈强免疫反应，91%的病例与胱抑素C抗体的免疫反应较弱。我们的数据表明，在血压正常的老年患者中，CAA是小脑脑出血以及脑叶脑出血的重要病因。
