脑淀粉样血管病相关炎症的临床诊断Clinical diagnosis of cerebral amyloid angiopathy-related inflammation
杜彬彬;秦伟伟;贺爽;杨阿莉;张杰文;陈帅;
摘要(Abstract)：
目的总结脑淀粉样血管病相关炎症(CAA-RI)患者的临床表现及辅助检查的特点,探讨临床诊断的要点。方法本研究纳入2016-07—2018-07在河南省人民医院诊治的10例CAA-RI患者,总结其临床表现、诊治经过及随访情况。分析头颅MRI上白质病变和CAA相关出血病变的特点及分布情况。结果本组CAA-RI患者临床症状上以认知障碍最为常见,头痛发生率较国外高,临床表现多样化,无诊断特异性。头颅MRI显示,脑白质病变特征均符合血管源性水肿,以FLAIR序列显示最佳,皮质下白质(U型纤维)均受累。CAA相关出血影像,以脑微出血发生率最高(100%),SWI序列对诊断非常重要。结论CAA-RI临床表现多样化,无诊断特异性。头颅MRI特征性白质病变合并CAA相关出血影像特征为诊断核心。
关键词(KeyWords)： 脑淀粉样血管病;认知障碍;磁共振;脑白质病变;血管炎
基金项目(Foundation): 国家自然科学基金(编号:81873727;81671068)
作者(Authors): 杜彬彬;秦伟伟;贺爽;杨阿莉;张杰文;陈帅;
参考文献(References)：
- [1] YAMADA M.Cerebral amyloid angiopathy:emerging concepts[J].J Stroke,2015,17(1):17-30.
- [2] SAKAI K,YAMADA M.Cerebral amyloid angiopathy[J].Brain Nerv,2014,66(7):827-835.
- [3] COROVIC A,KELLY S,MARKUS H S.Cerebral amyloid angiopathy associated with inflammation:A systematic review of clinical and imaging features and outcome[J].Int J Stroke,2018,13(3):257-267.
- [4] SCHAUMBERG J,TRAUSCHEID M,ECKERT B,et al.Cerebral amyloid angiopathy associated with inflammation[J].Nervenarzt,2018,89(6):682-691.
- [5] PIAZZA F,GREENBERG S M,SAVOIARDO M,et al.Anti-amyloid beta autoantibodies in cerebral amyloid angiopathy-related inflammation:implications for amyloid-modifying therapies[J].Ann Neurol,2013,73(4):449-458.
- [6] RENARD D,TATU L,COLLOMBIER L,et al.Cerebral Amyloid Angiopathy and Cerebral Amyloid Angiopathy-Related Inflammation:Comparison of Hemorrhagic and DWI MRI Features[J].J Alzheimers Dis,2018,64(4):1113-1121.
- [7] WEBER S A,PATEL R K,LUTSEP H L.Cerebral amyloid angiopathy:diagnosis and potential therapies[J].Expert Rev Neurother,2018,18(6):503-513.
- [8] CHUNG K K,ANDERSON N E,HUTCHINSON D,et al.Cerebral amyloid angiopathy related inflammation:three case reports and a review[J].J Neurol Neurosurg Psychiatry,2011,82(1):20-26.
- [9] AGHETTI A,SENE D,POLIVKA M,et al.Cerebral Amyloid Angiopathy Related Inflammation With Prominent Meningeal Involvement.A Report of 2 Cases[J].Front Neurol,2019,10:984.
- [10] SILEK H,ERBAS B.Cerebral Amyloid Angiopathy Related Inflammation Presenting As Steroid Responsive Brain Mass[J].Turk Neurosurg,2018 Sep 11.
- [11] BERLIT P,KEYVANI K,KRAMER M,et al.Cerebral amyloid angiopathy and dementia[J].Nervenarzt,2015,86(10):1248-1254.
- [12] KUSAKABE K,INOUE A,MATSUMOTO S,et al.Cerebral amyloid angiopathy-related inflammation with epilepsy mimicking a presentation of brain tumor:A case report and review of the literature[J].Int J Surg Case Rep,2018,48:95-100.
- [13] SAVOIARDO M,ERBETTA A,DI F J C,et al.Cerebral amyloid angiopathy-related inflammation:an emerging disease[J].Neuroradiol J,2011,24(2):253-257.
- [14] SAKAI K,HAYASHI S,SANPEI K,et al.Multiple cerebral infarcts with a few vasculitic lesions in the chronic stage of cerebral amyloid angiopathy-related inflammation[J].Neuropathology,2012,32(5):551-556.
- [15] SALVARANI C,MORRIS J M,GIANNINI C,et al.Imaging Findings of Cerebral Amyloid Angiopathy,Abeta-Related Angiitis (ABRA),and Cerebral Amyloid Angiopathy-Related Inflammation:A Single-Institution 25-Year Experience[J].Medicine (Baltimore),2016,95(20):e3613.
- [16] TETSUKA S,AUID-O H O,HASHIMOTO R,et al.Slightly Symptomatic Cerebral Amyloid Angiopathy-Related Inflammation with Spontaneous Remission in Four Months[J].Case Rep Neurol Med,2019,2019:5308208.
- [17] TANIGUCHI Y,KITAMURA T,INOUE H,et al.Amyloid beta related angitis without marked leukoencephalopathy[J].Rinsho Shinkeigaku,2019,59(12):814-817.