Moody D M, Brown W R, Challa V R, Ghazi-Birry H S, Reboussin D M
Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1088, USA.
Ann N Y Acad Sci. 1997 Sep 26;826:103-16. doi: 10.1111/j.1749-6632.1997.tb48464.x.
We have been using alkaline phosphatase (AP) histochemical staining, formerly a research tool for the study of cerebral cortical vascular morphology, to examine pathological changes in the cortex and deep cerebral structures. Deep structures stain similarly to the cortex. The AP stain is found in the afferent vessels (small arteries, arterioles, and capillaries), but not in venules and veins. The stain is also present in leaky vessels, such as those in the area postrema. The vascular supply to the cerebrum is not homogeneous. Supply to the deep white matter, for instance, derives from the leptomeningeal border zone, and then medullary arterioles must wind their way for up to 4 cm before arriving at their ultimate destination. Adding to the difficulties, tortuosities develop in some of these vessels with aging. According to some calculations, hypertensive levels of blood pressure would be required to maintain irrigation through some of these vessels. We have identified a venous alteration that attends aging: periventricular venous collagenosis (PVC) is a previously unrecognized, noninflammatory, mural disease of the periventricular veins. In severe cases, examples can be found of veins that are completely occluded by this process. PVC is found in 65% of subjects over 60 years old, and it strongly correlates with leukoaraiosis. In addition to previously mentioned aging-related changes, we have found extreme tortuosity, multiplications, and aneurysms of the smallest arterioles and lumpy-bumpy capillaries in the deep structures of patients with Alzheimer's disease.
我们一直在使用碱性磷酸酶（AP）组织化学染色法（该方法以前是研究大脑皮质血管形态的一种研究工具）来检查皮质和大脑深部结构的病理变化。深部结构的染色与皮质相似。AP染色见于传入血管（小动脉、微动脉和毛细血管），但不见于小静脉和静脉。该染色也存在于渗漏血管中，如最后区的血管。大脑的血管供应并不均匀。例如，深部白质的血液供应来自软脑膜边界区，然后髓质小动脉必须蜿蜒前行达4厘米才能到达其最终目的地。更困难的是，随着年龄增长，这些血管中的一些会出现迂曲。根据一些计算，需要高血压水平的血压才能维持通过其中一些血管的灌注。我们发现了一种与衰老相关的静脉改变：脑室周围静脉胶原化（PVC）是一种以前未被认识的、非炎症性的脑室周围静脉壁疾病。在严重的病例中，可以发现一些静脉被这个过程完全阻塞。65%的60岁以上受试者存在PVC，并且它与脑白质疏松症密切相关。除了上述与衰老相关的变化外，我们还在阿尔茨海默病患者的深部结构中发现了最小动脉和颗粒状毛细血管的极度迂曲、增多和动脉瘤形成。
