陈特综合征中阿片相关损伤的组织病理学相关性:首次尸检报告

IF 9.3 1区 医学 Q1 CLINICAL NEUROLOGY Acta Neuropathologica Pub Date : 2024-08-31 DOI:10.1007/s00401-024-02797-9
Katherine E. Schwetye, Lakshmi Ramachandran Nair, Joseph Boyle, Jed A. Barash
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引用次数: 0

摘要

阿片类药物相关脑损伤可能涉及选择性区域,包括单纯海马、苍白球和小脑半球。例如,阿片相关失忆综合征就是海马损伤的一种临床表现,表现为核磁共振成像异常。当这三个区域都受累时,可能是一种更严重的损伤,这种综合征被称为 "小脑、海马和基底核一过性水肿伴弥散受限(CHANTER)",最初是在 2019 年描述的。据我们所知,迄今为止,CHANTER 综合征的影像学发现还没有组织病理学相关性。在此,我们首次展示了一名因芬太尼中毒后并发 CHANTER 综合征而死亡的患者的尸检脑组织病理学结果。这些观察结果包括微出血、反应性和坏死性血管、嗜酸性粒细胞性神经元坏死、轴突肿胀和球形体以及明显的梗死。这些研究结果支持以前的实验模型,即缺氧缺血和细胞毒性机制都与陈氏综合征的组织损伤有关,但还需要进一步研究,以更好地确定所涉及的确切细胞通路,从而开发出有针对性的治疗方法。
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Histopathologic correlates of opioid-associated injury in CHANTER syndrome: first report of a post-mortem examination

Opioid-associated brain injury may involve selective regions, including the hippocampi alone, globi pallidi, and cerebellar hemispheres. Opioid-associated amnestic syndrome, for example, is one clinical correlate of hippocampal injury as manifest by MRI abnormality. When all three regions are involved in what may be a more fulminant injury, the syndrome is termed “cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER)”, initially described in 2019. Until now, to our knowledge, there have been no histopathologic correlates to the imaging findings specifically in CHANTER syndrome. Here, for the first time, we present histopathologic findings of the post-mortem brain from a patient who died from complications of CHANTER syndrome following fentanyl intoxication. These observations included microhemorrhage, reactive and necrotic vasculature, eosinophilic neuronal necrosis, axonal swelling and spheroids, and frank infarction. The findings support previous experimental models implicating both hypoxic–ischemic and cytotoxic mechanisms in the tissue damage associated with CHANTER syndrome, though further work is needed to better characterize the exact cellular pathways involved to develop targeted treatments.

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来源期刊
Acta Neuropathologica
Acta Neuropathologica 医学-病理学
CiteScore
23.70
自引率
3.90%
发文量
118
审稿时长
4-8 weeks
期刊介绍: Acta Neuropathologica publishes top-quality papers on the pathology of neurological diseases and experimental studies on molecular and cellular mechanisms using in vitro and in vivo models, ideally validated by analysis of human tissues. The journal accepts Original Papers, Review Articles, Case Reports, and Scientific Correspondence (Letters). Manuscripts must adhere to ethical standards, including review by appropriate ethics committees for human studies and compliance with principles of laboratory animal care for animal experiments. Failure to comply may result in rejection of the manuscript, and authors are responsible for ensuring accuracy and adherence to these requirements.
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