同侧同时多发性高血压脑内出血:血肿形成分析及与高血压混合型血肿分布的比较。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY Neuropathology Pub Date : 2024-08-06 DOI:10.1111/neup.12998
Shigeki Takeda, Hitoshi Takahashi, Teruo Miyakawa, Kazunori Yamazaki, Kiyoshi Onda
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引用次数: 0

摘要

一名 55 岁的日本妇女有高血压和右侧普坦门出血病史,左侧丘脑和普坦门同时出血,24 小时后死亡。患者脑部无血管异常。突触素免疫染色联合天青素 50(EA50)染色可清楚地识别血肿和周围的脑结构。在右侧大脑半球,明显可见囊性病变,这是常见的高血压性椎管内血肿的后遗症。左侧大脑半球有两个明显的新鲜血肿。α-平滑肌肌动蛋白免疫染色法结合 EA50 和 Victoria bleu 染色法显示,丘脑前核和大脑前部有三条破裂的动脉,并伴有纤维蛋白聚集。丘脑和丘脑前部明显可见一些由纤维蛋白组成的圆形结构,表明附近存在破裂的动脉。在大脑丘脑,从外侧到内侧区域都有破裂的动脉和圆形结构。丘脑前核中的纤维蛋白聚集物数量多于普方肌中的纤维蛋白聚集物。根据这些发现,我们得出以下结论(i) 丘脑前核中有大量纤维蛋白聚集的动脉首先破裂,其次是分布在丘脑其他部位和普特间脑的动脉;(ii) 不寻常的普特间脑血肿是由于普特间脑中心周围的动脉破裂造成的,而这种动脉破裂并不是常见的高血压性普特间脑血肿的原因;(iii) 研究表明,即使同侧的普脑和丘脑同时发生高血压出血,也不会形成常见的高血压混合型血肿。
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Ipsilateral simultaneous multiple hypertensive intracerebral hemorrhages: Analysis of hematoma formation and comparison with distribution of hypertensive mixed-type hematoma.

A 55-year-old Japanese woman with a history of hypertension and right putaminal hemorrhage developed simultaneous hemorrhages in the left thalamus and putamen and died 24 h later. There were no vascular anomalies in the brain. Synaptophysin immunostaining combined with eosin azure 50 (EA50) staining clearly identified the hematoma and the surrounding brain structures. In the right cerebral hemisphere, a cystic lesion as a sequela of the usual type of hypertensive putaminal hematoma was evident. In the left cerebral hemisphere, two fresh hematomas were evident. One was a thalamic hematoma, which had destroyed the dorsal and medial structures of the thalamus, and the other was an unusual putaminal hematoma, which had destroyed the entire putamen and crossed the internal capsule and caudate nucleus. α-Smooth muscle actin immunostaining combined with EA50 and Victoria bleu staining demonstrated three ruptured arteries associated with fibrin aggregates in the anterior thalamic nucleus and anterior putamen. Some circular structures composed of fibrin, suggesting the presence of ruptured arteries in the neighborhood, were evident in the thalamus and putamen. In the putamen, ruptured arteries and circular structures were present in the lateral to medial areas. Fibrin aggregates in the anterior thalamic nucleus were more numerous than those in the putamen. On the basis of these findings, we concluded that: (i) the artery with numerous fibrin aggregates in the anterior thalamic nucleus had ruptured first, followed by the arteries distributed in other parts of the thalamus and putamen; (ii) the unusual putaminal hematoma was attributable to rupture of the arteries around the center of the putamen, which are not responsible for the usual type of hypertensive putaminal hematoma; and (iii) it is suggested that even if hypertensive hemorrhage occurs simultaneously in the ipsilateral putamen and thalamus, the usual type of hypertensive mixed-type hematoma does not form.

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来源期刊
Neuropathology
Neuropathology 医学-病理学
CiteScore
4.10
自引率
4.30%
发文量
105
审稿时长
6-12 weeks
期刊介绍: Neuropathology is an international journal sponsored by the Japanese Society of Neuropathology and publishes peer-reviewed original papers dealing with all aspects of human and experimental neuropathology and related fields of research. The Journal aims to promote the international exchange of results and encourages authors from all countries to submit papers in the following categories: Original Articles, Case Reports, Short Communications, Occasional Reviews, Editorials and Letters to the Editor. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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