Hemorragias cerebrales y angiopatía amiloidea / Cerebral amyloid angiopathy in brains of patients dying of non traumatic cerebral hemorrhages

Background: Cerebral amyloid angiopathy is considered pathogenic in non traumatic cerebral lobar hemorrhages. Aim: To study the frequency of cerebral amyloid angiopathy in brains of patients dying of non traumatic cerebral hemorrhages. Material and methods: Thirty seven brains from patients, 25 men and aged 65ñ10 years old, with cerebral hemorrhages (14 lobar, 18 in basal ganglia and 5 in cerebellum or brainstem) were studied. As controls, the brains of 30 subjects, 14 men and aged 64ñ16 years old, dying of non neurological causes were studied. Deep and cortical vessels were stained with hematoxylin eosin, Gomori, Thioflavin T and Bodian. Definitive cerebral amyloid angiopathy was diagnosed when amyloid deposition was observed in the media of vessels. Results: Twenty six out of 32 patients dying of cerebral hemorrhage and 3 of 21 controls had chronic hypertension. Cerebral amyloid angiopathy was present in 19 of 37 brains of patients with cerebral hemorrhage and 13 of 30 control brains. In patients with hypertension, vascular changes independent of the location and volume of amyloid deposition, were observed. Such changes were dilatation, tortuousness, thickening of walls specially in muscular and adventitia and hyaline degeneration. Thirteen brains with hemorrhage had fibrinoid necrosis and 10 had microaneurysms. Conclusions: In this series of patients, cerebral amyloid deposition was unspecific and its role in the pathogenesis of cerebral hemorrhages was not confirmed. Hypertension was associated with vascular degenerative changes that can lead to cerebral hemorrhages

Mononeuropatía múltiple y vasculitis / Multiple mononeuropathy and vasculitis

Background: Seventy percent of vasculitis are neurologically expressed as multiple mononeuropathy (MM) or asymmetrical neuropathy (AN). Concurrent nerve and muscle biopsy increases the diagnostic accuracy of the disease. Aim: To define the pathological features of vascular damage in nerve and muscle in patients with MM or AN. Patients and methods: Between 1980 and 1997, 50 patients with a MM or AN diagnosis, based on neurological and neurophysiological findings, were studied at the Neurology Department of Hospital del Salvador. All underwent nerve and muscle biopsy (of the superficial peroneal nerve and the short peroneal muscle). Slices were stained with hematoxylin eosin, luxol fast blue and Gomori staining. Results: Forty two patients, aged 52 ñ 15 years old (29 female) had a vasculitis. These subjects with MM or AN associated to vasculitis, corresponded to 22 percent of neuropathies subjected to nerve biopsy at the Department in the study period. Thirty two cases (76 percent) had necrotizing arteritis, characterized by wall fibrinoid necrosis and lumen occlusion in large vessels (>100 microns), with Iymphoplasmocytic and macrophage infiltration. Ten cases showed an inflammatory reaction and endothelial proliferation without wall necrosis, specially in small epineural arteries. Vascular recanalization was found in 33 percent of cases. Diagnostic vascular changes were found in 87 percent of nerve biopsies and 53 percent of muscle biopsies. No definitive relationship between the intensity of vascular and nerve lesions was found. All muscle biopsies showed some degree of neurogenic atrophy and 5 had micro infarcts. Conclusions: Superficial peroneal nerve biopsy is diagnostic in most patients with MM or AN associated with vasculitis. Nerve and muscle biopsies are complementary in the diagnostic work up