A retrospective study of 26 cases of pathologically established cerebral amyloid angiopathy / 中华神经科杂志

Objective To study the clinical feature of 26 cases which were diagnosed pathologically as cerebral amyloid angiopathy ( CAA ) and to improve the level of diagnosis.Methods The clinical characteristics of the 26 cases with CAA in our hospital from 1983 to 1999 were retrospectively reviewed and analyzed,including previous history,clinical manifestation,and laboratory examination.Results Of the 26 CAA patients,there were 17 men and 9 women with age ranging from 45 to 78 years.Eight patients (30.7％ ) had the history of hypertension; 6 cases (23.1％ ) suffered from diabetes; 2 patients(7.6％ ) were taking anticoagulant or antiplatelet agents in whom serious CAA and multiple hemorrhages were histopathologically confirmed by autopsy.There were 20 cases diagnosed as cerebral hemorrhage,including 2 patients with single lobe hemorrhage,8 patients with multiple lobe hemorrhage,5 patients with putamen hemorrhage,2 patients with cerebral ganglion hemorrhage,2 patients with cerebellar hemorrhage,and 1 patient with brain stem hemorrhage.Of the 26 CAA patients,there were 2 patients with subaracchnoid hemorrhage,1 patient with hemorrhagic cerebral infarction,1 patient with basal ganglia infarction,1 patient with basilar artery occlusion,1 patient with subdural hematoma.The clinical manifestation of the 20 cases diagnosed as cerebral hemorrhage included headache,limb palsy,coma,and hyperspasmia.Conclusions CAA always begin as cerebrovascular disease symptoms with or without hypertension.The most common manifestation of CAA is lobe hemorrhage,while the CAA-related hemorrhage seldom occurs in basal ganglia,cerebellum and brainstem.CAA can also manifest cerebral infarction and subarachnoid hemorrhage.Anticoagulant (warfarin) or antiplatelet agents (aspirin) maybe a contributing factor for CAA-related hemorrhage.

Clinical and pathological study of basilar artery aneurysm / 临床神经病学杂志

Objective To discuss the clinical characteristics and pathological changes of basilar artery aneurysm.Methods The clinical materials and brain topography results were analyzed retrospectively in 4 patients with basilar artery aneurysm.Results The onsets of disease in all cases were acute and common manifestations were coma,positive meningeal irritation sign and ocular dyskinesis.3 cases showed hypertention,2 cases presented with hemiparalysis,all cases died of herniation.3 cases of basilar artery trunk fusiform aneurysm and 1 case of basilar artery furcation saccular aneurysm were detected in autopsy.There were aneurysm rupture,subarachnoid hemorrhage and swell,necrosis,softening,gliosis of brain tissue confirmed pathologically in all cases.Conclusion Hypertension is probably the most important cause of aneurysm rupture.Signs and symptoms of subarachnoid are the most common manifestation when basilar artery aneurysm ruptures with poor prognosis.Herniation is the main cause of death.

Clinical and pathological features of herniation secondary to cerebral infarction / 临床神经病学杂志

Objective To discuss the clinical and pathological features of herniation secondary to cerebral infarction. Method Clinical and pathologic characteristics of 50 cases died of herniation due to cerebral infarction were analysised. Results The clinical manifestations,such as consciousness disturbance,pupillary change,hemiplegia or tetraplegia were detected in all 50 cases,the average time from onset to herniation was (3.36?1.12)d,the time herniation to death was 20 h～7 d,average about (1.5?0.98)d. The large size cerebral infarctions caused by internal carotid artery,middle cerebral artery and/or vertebral artery occlusion were pathologically confirmed.hemorrhagic cerebral infarctions caused by cerebral embolism were found in 25 cases and the ischenmic infarctions caused by cerebral thrombosis in 25 caese.Site of infarction were cerebral hemisphere (31 cases), brain stem (15 cases), supratentorial and infratentorial brain (4 cases).Of the 50 cases,36 cases had hippocampal gyrus herniation,36 cases with cerebellur throat-almond herniation,18 cases with central herniation,17 cases with cingulated gyrus herniation,and 27 cases with sphenoidal crest herniation. Usually there were several herniation existing in the same patient. Among 50 cases,11cases had two kinds of herniation,10 cases with three kinds of herniation,9 cases with four kind of herniation, and 5 cases with five kinds of herniation.Conclusions Herniation secondary to cerebral infarction were mainly presented in the large size cerebral infarction caused by internal carotid artery or middle cerebral artery occlusion.the time of herniation was in early stage of disease.Most of patients were hippocampal gyrus herniation and cerebellur throat-almond herniation.Usually there were several herniation existing in the same patient.

Clinical, imaging and pathological features of intracerebral inflammatory pseudotumour (report of 1 case) / 临床神经病学杂志

Objective To investigate the clinical,imaging (CT and MRI) and pathological features of intracerebral inflammatory pseudotumour. Methods The clinical, neuroimaging and neuropathological data of a patient with intracerebral inflammatory pseudotumour were analyzed retrospectively. Results The manifestations of this patient included headache, nausea, vomiting, fever and seizures. Brain MRI showed abnormal high T1 and T2 signals in the right frontal lobe and midline shift. The resection pathology showed brain tissue swelling, loss of normal neuron outline, massive inflammatory infiltrations in perivascular spaces. Although the patient was treated with operation, dehydration and antibiotics, he died eventually.Conclusions Intracerebral inflammatory pseudotumour is an unusual disease in clinical practice. This disease is diagnosed mainly depended upon pathological examinations because of no specific clinical and imaging manifestations. The prognosis is not good although operative treatment is performed.

Cerebral hemorrhage associated with cerebral amyloid angiopathy / 第二军医大学学报

Objective: To investigate the clinical and pathological features of patients with cerebral amyloid angiopathy (CAA) related cerebral hemorrhage (C A AH). Methods : The clinical data of 5 patients with C A AH, including clinical manifestations, neuroimaging and topographical anatomy features were studied. Results: It was found that the onset and clinical manifestations of CAAH resembled hypertensive cerebral hemorrhage. CAAH could coexist with hypertension and hypertension might aggravate the pathological changes of CAA. Typical CAAH located in cortical and subcortical areas, but cerebral hemorrhage located in the basal ganglia and thalamus could not ruled out CAAH without the pathological confirmation of CAA. The neuroimages of some specific types of cerebral hemorrhage, such as insular cistern hematoma and subarachnoid hemorrhage, could manifest as hypertonial putaminal hemorrhage, but their outcomes were distinctly different. Conclusion: The causes of cerebral hemorrhage include hypertension and cerebral amyloid angiopathy, and CAA may have an important clinical value.