RESUMEN
A 23-year-old female patient with primary vasculitis of the central nervous system simulating a brain tumor is described. The clinical picture was represented by migraine-like headaches, ataxia, transient numbness of the right leg, the lips, double vision, a slight decrease of cognitive functions. MRI of the brain revealed a tumor-like focus in the cerebellum, intensively accumulating contrast, containing micro-hemorrhages (SWI mode). Small single ischemic foci in the brain hemispheres and brain stem were also found. MR angiography (3T) did not found any pathology. Examination of the cerebrospinal fluid revealed a small cytosis (mainly T-lymphocytes) and a slight increase in protein. The results of the analysis of cerebrospinal fluid for syphilis, tuberculosis and the herpetic group of viruses were negative, type 1 oligoclonal synthesis was found. Blood tests for toxoplasmosis, antibodies to aquaporin, anti-neutrophil antibodies, markers of systemic inflammation were within normal limits. Different diagnoses were assumed: demyelinating disease, encephalitis, multiple encephalomyelitis, lymphoma. The diagnosis was established only by a brain biopsy - lymphocytic vasculitis was revealed. According to the immunohistochemical study, T-helpers predominated in the infiltrates. After pulse therapy with Metylprednisolon (1000 mg intravenously drip â. 5), the patient's condition almost returned to normal. It was recommended to take prednisolone per os (starting dose 60 mg) for 7 months.
Asunto(s)
Sistema Nervioso Central , Vasculitis del Sistema Nervioso Central , Femenino , Humanos , Adulto Joven , Anticuerpos , Ataxia , Encéfalo/diagnóstico por imagen , Vasculitis del Sistema Nervioso Central/diagnóstico por imagen , Vasculitis del Sistema Nervioso Central/tratamiento farmacológicoRESUMEN
Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst's encephalitis, is a rare demyelinating disease of the central nervous system characterized by rapid progression and acute inflammation of the white matter of the brain and spinal cord. AHLE is currently considered as a rare, most severe variant of acute disseminated encephalomyelitis. Clinically AHLE is characterized by a fulminant course with a rapid development of encephalopathy and multifocal neurological symptoms. AHLE is associated with high mortality rate that requires immediate and aggressive treatment initiation. This article describes a case of AHLE with an atypical course, a subacute form, which is extremely rarely described in the literature, with the progressive symptoms' development over several months. Due to delayed treatment initiation, unfortunately, a fatal outcome has been observed. Subsequent histological examination of the autopsy material confirmed the presence of a subacute form of AHLE in the patient.
Asunto(s)
Encefalitis , Encefalomielitis Aguda Diseminada , Leucoencefalitis Hemorrágica Aguda , Humanos , Leucoencefalitis Hemorrágica Aguda/diagnóstico , Leucoencefalitis Hemorrágica Aguda/patología , Encéfalo/patología , Médula Espinal , Encefalitis/patología , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVE: Identification of morphological manifestations and evaluation of morphometric parameters of the nervous tissue in various structures of the human brain during aging. MATERIAL AND METHODS: Autopsy material was obtained from patients whose causes of death were not associated with neurological diseases. Three age groups were studied: young (35-45 years old) (n=10); eldery (75-89 years old) (n=20); centenarians (over 90 years old) (n=10). Quantitative analysis of large neurons in the compact part of the substantia nigra, basal ganglia, layer V of the cortex, and the pyramidal layer of the hippocampus was carried out. In addition, the brain mass, the thickness of the cortex of the precentral gyrus were measured, the glial index was calculated, and the morphological signs of age-related involution of the brain tissue and intracerebral vessels were assessed. RESULTS: In senile and centenarians, compared with young people, there was a progressive reduction in large neurons of layer V of the cortex, basal ganglia, the pyramidal layer of the hippocampus and substantia nigra, a decrease in brain mass and thickness of the cortex of the precentral gyrus, as well as an increase in the glial index. Changes in blood vessels characteristic of aging are described. Also, during aging, signs characteristic of neurodegeneration were found. CONCLUSION: The results of the study confirm that such brain structures as the cortex of the precentral gyrus, the hippocampus, the basal ganglia, and the substantia nigra lose large neurons with age, followed by the development of gliosis. The identified morphological changes characteristic of aging are phenomenologically similar to a certain set of morphological changes in neurodegenerative diseases of late age.
Asunto(s)
Tejido Nervioso , Sustancia Negra , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento , Encéfalo , Humanos , Persona de Mediana Edad , NeuronasRESUMEN
Postmortem studies are of great importance in evaluating the effectiveness of clinical, diagnostic, therapeutic, and preventive measures aimed at combating a social disease, such as dyscirculatory encephalopathy, the leading causes of which are hypertension and atherosclerosis. The complexity of these studies is largely determined by a variety of brain changes with the frequent concurrence of hypertension and severe cerebral atherosclerosis and, at the same time, the similarity of some changes, for example, the localization and size of hypertensive and atherosclerotic lacunar infarcts. The paper describes a case of dyscirculatory encephalopathy with multiple small focal cerebral ischemic changes caused by both hypertension and athero-stenosis of several arteries in both the brain carotid systems and the vertebrobasilar system, namely tandem stenoses. It has been established that small infarcts in tandem stenosis can result from adaptive processes in the intracranial arteries. These infarcts have some features of localization, such as the areas of adjacent blood supply to the cerebral hemispheres and cerebellum, as well as the deep regions of the brainstem. It is shown that arterial pathological changes in the ischemic zones permit one to make a differential diagnosis of hypertensive lacunar infarcts and the same infarcts arising in tandem stenoses. In addition, among the typological signs of hypertensive lacunar infarcts, there are enlarged perivascular spaces in the peri-infarct region and ischemic destruction of myelin in the periventricular regions of the brain.
Asunto(s)
Aterosclerosis , Hipertensión , Encéfalo/diagnóstico por imagen , Arterias Cerebrales , Humanos , Hipertensión/complicacionesRESUMEN
Hypertension is the main cause and the most important risk factor for both acute cerebrovascular accident and chronic progressive cerebrovascular insufficiency that is accompanied by severe neurological and mental disorders even to the extent of developing dementia. They are based on hypertension-induced pathology of the intracerebral arteries and cerebral microvasculature - cerebral microangiopathy that leads to small deep (lacunar) infarcts (SDIs) and diffuse cerebral white matter diseases. This review highlights the morphology, pathogenesis, clinical and neuroimaging diagnosis of hypertensive SDIs, and their differential diagnosis with atherosclerotic SDIs in the historical aspect. It is emphasized that the lacunar state of the brain in hypertension is a predictor of massive cerebral hemorrhages. Special attention is paid to current studies of the morphology and pathogenesis of diffuse changes in white matter and to the role of blood-brain barrier impermeability in the development of progressive leukoencephalopathy.
Asunto(s)
Enfermedades de los Pequeños Vasos Cerebrales , Trastornos Cerebrovasculares , Hipertensión , Accidente Vascular Cerebral Lacunar , Encéfalo/diagnóstico por imagen , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Trastornos Cerebrovasculares/complicaciones , Trastornos Cerebrovasculares/diagnóstico , Humanos , Hipertensión/complicaciones , Imagen por Resonancia MagnéticaRESUMEN
The authors revealed relation between the structure of an atherosclerotic plaque (ASP) and intensity of the ultrasound signal reflected form the ASP. Our prospective pilot study included a total of 90 patients (71 men and 19 women aged from 47 to 79 years, with the median age 62 years) presenting with atherosclerotic stenosis of the carotid sinus (CS) and undergoing treatment at the Research Centre of Neurology (Moscow) from April 2015 to March 2016. All patients underwent ultrasonographic examination followed by morphological study of the structure of the plaques removed during carotid endarterectomy (CEA). It was revealed that intensity of the ultrasound signal from an ASP depended on the morphological structure of the ASP components: the foci of atheromatosis were associated with an ultrasound range of 1.1-5.6 dB, those of fibrosis - with the range 23.1-30.5 dB, and those of calcinosis - with the range 42.3-44.7 dB (presented are the values from the 15th to 85th percentiles). It was determined that an increase of intensity of the ultrasound signal reflected from the foci of atheromatosis and fibrosis in the ASP was associated with the presence of small calcificates therein, and a decrease of intensity of the ultrasound signal from the portions of fibrosis in the ASP - with large accumulation of lipophages or newly formed vessels in these portions.
Asunto(s)
Seno Carotídeo/diagnóstico por imagen , Estenosis Carotídea , Endarterectomía Carotidea/métodos , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/patología , Ultrasonografía/métodos , Anciano , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/etiología , Estenosis Carotídea/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/complicaciones , Reproducibilidad de los ResultadosRESUMEN
Primary central nervous system lymphoma (PCNSL) is a rare aggressive extranodal non-Hodgkin lymphoma. Difficulties in diagnosing PCNSL are associated with the absence of pathognomonic clinical and neuroimaging findings of this disease. The article describes the clinical case of a female patient with autopsy-confirmed multifocal large-cell B-cell CNS lymphoma misdiagnosed as acute disseminated encephalomyelitis (ADEM). Clinical and neuroimaging characteristics of PCNSL and ADEM as well as the role of diagnostic methods in establishing the correct diagnosis are discussed.
Asunto(s)
Neoplasias del Sistema Nervioso Central/complicaciones , Encefalomielitis Aguda Diseminada , Linfoma , Diagnóstico Diferencial , Encefalomielitis Aguda Diseminada/etiología , Femenino , Humanos , Linfoma/complicaciones , Imagen por Resonancia Magnética , NeuroimagenRESUMEN
OBJECTIVE: To quantify the morphochemical characteristics of Lewy bodies detected in the substantia nigra in patients with Parkinson's disease (PD). MATERIAL AND METHODS: The investigators studied the localization of alpha-synuclein (α-Syn) and the distribution of neurofilament protein and synaptophysin by immunohistochemical assas and compared with the results of interferometry and computer-assisted morphometry of Lewy bodies in the autopsy specimens of the substantia nigra from PD patients. RESULTS: Three groups of synuclein-positive aggregates differing in shape were identified. Mature Lewy bodies had a rounded shape, a concentric structure, a poorly stained core, and, as compared with neuropil, a high phase difference value. Comparison of the localization of α-Syn, neurofilaments, and synaptophysin showed that immunostaining of neurofilaments in the peripheral layer of Lewy bodies was shifted closer to the nucleus and the localization of synaptophysin and α-Syn coincided. CONCLUSION: Synuclein-positive protein aggregates showed heterogeneity in structure, shape, and protein composition in PD. The localization of neurofilament protein and synaptophysin in Lewy bodies attests that the cytoskeleton and neuronal synaptic vesicle trafficking in the substantia nigra are impaired in BP.
Asunto(s)
Cuerpos de Lewy/metabolismo , Proteínas de Neurofilamentos/metabolismo , Enfermedad de Parkinson/metabolismo , alfa-Sinucleína/metabolismo , Anciano , Autopsia , Femenino , Humanos , Cuerpos de Lewy/patología , Masculino , Persona de Mediana Edad , Proteínas de Neurofilamentos/aislamiento & purificación , Neuronas/metabolismo , Neuronas/patología , Neurópilo/metabolismo , Enfermedad de Parkinson/patología , Sustancia Negra/metabolismo , Sustancia Negra/patología , Sinaptofisina/aislamiento & purificación , Sinaptofisina/metabolismo , alfa-Sinucleína/aislamiento & purificaciónRESUMEN
OBJECTIVE: to identify the relationship between the magnitude of neovascularization of an atherosclerotic plaque and its other processes, such as atheromatosis, macrophage responses, hemorrhages, and calcification. MATERIAL AND METHODS: 48 carotid atherosclerotic plaques all their way underwent morphopathological examination, by assessing the magnitude of neovascularization (total vessel density per plague cm2; density of vessels of different diameters; localization in section), atheromatosis (a volume fraction), foam cells (a score of 0 to 5), hemorrhages (a score of 0 to 4), and calcification (a score of 0 to 4). The Mann-Whitney U test and the Spearman correlation coefficient with p<0.05 were used in the statistical analysis. RESULTS: There was a substantial variability in vessel diameters and densities in the plaque with a drastic predominance of vessels smaller than 20 µm in diameter (69.8±14.3%). The vessels with a diameter as large as 20 µm were more frequently located in the area of accumulation of foam cells or organizing hemorrhages (p<0.03), unlike those with a diameter of more than 40 µm, which were more common in the areas of connective tissue, especially adjacent to large calcifications, and in the foci of organized hemorrhages (p<0.008). Intensified calcification was accompanied by the higher density of vessels having a diameter of more than 40 µm (p<0.038) and particularly of those with a diameter of more than 60 µm (p=0.006). The degree of hemorrhages and the number of foam cells were unrelated to the density of vessels, but these increased with their localization in the surface areas of a plaque (p=0.000342). With the increasing severity of atheromatosis, there was a decrease in the density of vessels larger than 20 µm in diameter (p=0.00042). CONCLUSION: The number, diameter, and location of vessels in the plaque serve as a dynamic reflection of its destructive and reparative processes; and a larger number of vessels having a diameter of more than 40 µm can be an indicator for the activation of reparative processes.
Asunto(s)
Aterosclerosis , Neovascularización Patológica , Placa Aterosclerótica , Aterosclerosis/patología , Arterias Carótidas , Hemorragia , Humanos , Placa Aterosclerótica/patologíaRESUMEN
AIM: to obtain more specific information on the morphology and pathogenesis of cerebral infarctions occurring in vertebrobasilar artery (VBA) atherosclerosis. MATERIAL AND METHODS: Macro- and microscopic investigations of the brain, its arterial system, and heart were conducted in 69 autopsy cases with infarctions located in the vertebrobasilar system (VBS) in atherosclerosis. RESULTS: 69 cases were found to have 206 VBA infarctions of various extent and locations. The detected infarctions were single and multiple in 27 and 42 cases, respectively. The detected infarctions included extensive (n=7), large (n=9), medium (n=63), small deep (lacunar) (n=97), and small superficial (n=30). The brain stem showed lacunar infarctions most frequently (76% of the infarctions at this site). Medium and small infarctions were identified at the same frequency in the cerebral hemispheres and cerebellum. The occurrence of 94% of the extensive and large infarctions was ascertained to be pathogenetically associated with atherothrombotic occlusion of the intracranial arteries in the VBS. 76% of the small infarctions occurred through the mechanism of cerebral vascular insufficiency in tandem atherostenosis of VBAs in conjunction with an additional decrease in cerebral blood flow under the influence of an extracerebral factor (coronary heart disease). Medium infarctions were approximately equifrequently due to the two aforementioned causes and, in some cases, to cardiogenic thromboembolism of VBAs. Infarctions were multiple in most cases; while recent large atherothrombotic infarctions were frequently concurrent with small organized infarctions resulting from tandem atherostenosis of VBAs. CONCLUSION: This investigation could establish the relationship between the site, extent, and pathogenetic factors of infarctions in the VBA bed in atherosclerosis, as well as the prognostic value of small infarctions as predictors for severe ischemic stroke.
Asunto(s)
Aterosclerosis , Isquemia Encefálica , Infarto Cerebral , Aterosclerosis/patología , Isquemia Encefálica/patología , Infarto Cerebral/patología , Humanos , PronósticoRESUMEN
A morphological study of 200 atherosclerotic carotid sinus (CS) plaques obtained at carotid endarterectomy revealed the structural components and processes characteristic for severe atherosclerosis (foci of atheromatosis and edema, necrosis of collagen and elastic fiber, newly formed vessels and hemorrhages of various duration, lipophages and lymphocytes, portions of fibrosis and calcification, covering thinning and ulceration, thrombi, and the contents of plagues (atheromatous masses, cholesterol crystals, lipophages, calcificates) on their surface). Clinical and morphological comparisons indicated that patients with stroke had a history of signs of severer atherosclerosis than those with asymptotic CS stenosis. They were found to have more commonly vulnerable atherosclerotic plaques that showed a predominance of atheromatosis foci over the portions of fibrosis and calcification, covering thinning and destruction, formation of thrombi onto its surface. It was ascertained that concomitant arterial hypertension might play a crucial role in the pathogenesis of hemorrhages into the atherosclerotic plague.
Asunto(s)
Aterosclerosis/patología , Seno Carotídeo/patología , Estenosis Carotídea/patología , Anciano , Anciano de 80 o más Años , Aterosclerosis/diagnóstico , Estenosis Carotídea/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A histological study was made of 140 atherosclerotic plaques in the sinus of the internal carotid artery (ICA) removed at carotid endarterectomy. New formed thin-walled vessels of various diameter having the structure of arteries, blocking arteries and, presumably, arteriolo-venous anastomoses were found in 112 plaques. The majority of the vessels were oriented along the ICA this indicating blood circulation parallel to that in ICA. It is assumed that deficiency of blocking arteries results in the development of intraplaque hemorrhages from thin-walled vessels.