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脑淀粉样血管病(CAA)是一种淀粉样蛋白限局性沉积于脑血管的疾病。随着年龄的增长,在正常老年人脑也可出现 CAA,是 Alzheimer 病(AD)最常见的病理变化,并作为脑出血原因之一已引起人们的关注。下面介绍由 CAA 引起脑出血的表现及最近开发的诊断方法。CAA 除了在蛛网膜下腔和脑皮质浅层小血管壁有淀粉样沉积外,还可见节段性的血管坏死、粟粒动脉瘤、血管闭塞、纤维化、管壁的双重化等,如此血管将变得脆弱和易出血。CAA 好发部位是在脑膜、大脑皮质和小脑皮质等处血管,而很少发生在易发生血管坏死等高血压性小动脉病变的大脑基底核和脑干。CAA 引起的脑出血患者血压多正常,既往很少有高血压,而且出血为多发性脑叶型和复发型。在 CAA 的脑出血中双侧脑叶型脑出血占20.5%,好发部位以额叶最多,基底核极少见。用上述病理学变化可解释这些特征。
Cerebral amyloid angiopathy (CAA) is a disease in which amyloid is localized to cerebrovascular disease. With age, CAA appears in the brain of normal elderly people, which is the most common pathological change of Alzheimer’s disease (AD) and has drawn people’s attention as one of the causes of cerebral hemorrhage. The following describes the performance of cerebral hemorrhage caused by CAA and the recent development of diagnostic methods. CAA in addition to amyloid deposition in the subarachnoid and shallow cortical small vessel wall, but also showed segmental vascular necrosis, miliary aneurysm, vascular occlusion, fibrosis, double wall and so on, so that the blood vessels will be Become vulnerable and bleeding. CAA predilection sites in the meninges, cerebral cortex and cerebellar cortex and other blood vessels, and rarely occurs in prone to vascular necrosis and other lesions of the cerebral basilar and brain stem. CAA caused by normal blood pressure in patients with intracerebral hemorrhage, with little prior high blood pressure, and bleeding for multiple cerebral lobar and recurrent. Cerebral hemorrhage in CAA bilateral cerebral lobe cerebral hemorrhage accounted for 20.5%, prone to the frontal lobe most, basal nuclei are rare. These features can be explained by the above pathological changes.