Vaz R, Sarmento A, Borges N, Cruz C, Azevedo I
Department of Neurology and Neurosurgery, Medical Faculty, Hospital S. João, Porto, Portugal.
Acta Neurochir (Wien). 1997;139(3):215-20. doi: 10.1007/BF01844754.
Brain tissue from 11 patients with traumatic cerebral contusions submitted to surgery was studied. Control biopsy specimens were obtained from 5 patients undergoing ventriculo-peritoneal shunts for "communicating" hydrocephalus. After collection, the small fragments were fixed by immersion in glutaraldehyde-osmium and embedded in Epon. Semi-thin sections stained with toluidine blue were observed with the light microscope. Thin sections stained with lead citrate and uranyl acetate were observed using a Jeol electron microscope. In tissues from patients with head trauma a clear space most probably corresponding to fluid accumulation was systematically observed around microvessels. Ultrastructurally endothelial cells from these specimens exhibited signs of marked intracellular oedema, tight junctions being intact. Pinocytotic activity was increased, mainly at the abluminal surface. Swelling of astrocytic perivascular processes and the appearance of macrophagic cells with voluminous lysosomes were also observed. The authors conclude that the oedema of endothelial cells probably represent a central fact in the pathophysiology of traumatic brain oedema and speculate on the putative involvement of stretch-activated receptors in this condition.
对11例接受手术的创伤性脑挫伤患者的脑组织进行了研究。对照活检标本取自5例因“交通性”脑积水而接受脑室 - 腹腔分流术的患者。采集后，小组织碎片通过浸入戊二醛 - 锇固定并包埋在环氧树脂中。用甲苯胺蓝染色的半薄切片用光学显微镜观察。用柠檬酸铅和醋酸铀染色的薄切片用日本电子显微镜观察。在头部外伤患者的组织中，在微血管周围系统地观察到一个很可能与液体蓄积相对应的清晰间隙。超微结构上，这些标本的内皮细胞表现出明显的细胞内水肿迹象，紧密连接完整。吞饮活性增加，主要在无腔面。还观察到星形胶质细胞血管周突肿胀以及出现带有大量溶酶体的巨噬细胞。作者得出结论，内皮细胞水肿可能是创伤性脑水肿病理生理学中的一个核心事实，并推测牵张激活受体在这种情况下可能的参与情况。
