重视脑淀粉样血管病相关炎症的诊治

Pay attention to the diagnosis and treatment of cerebral amyloid angiopathy-related inflammation

脑淀粉样血管病相关炎症是由沉积在脑皮质或软脑膜中的β-淀粉样蛋白所引起的炎性反应过程,属于脑淀粉样血管病中的少见类型。患者多为中老年,表现为进行性下降的认知功能障碍、头痛、癫痫发作及局灶性神经功能缺损等。头颅磁共振成像显示皮质及皮质下白质非对称性T2/液体衰减反转恢复序列高信号,并伴多发性微出血。该病常需与原发性中枢神经系统血管炎、胶质瘤、水痘-带状疱疹病毒性脑炎等疾病相鉴别。该病较少见,早期予以糖皮质激素或免疫抑制剂治疗可减少死亡与残疾,并明显改善预后,因此有必要提高临床医生对该病的早期诊治能力。

Cerebral amyloid angiopathy-related inflammation is an inflammatory reaction process caused by beta-amyloid protein deposited in the cortical and leptomeningeal vessels,which is a rare type of cerebral amyloid angiopathy.Most of the patients are middle-aged and elderly,and manifest as progressive cognitive impairment,headache,seizures,and focal neurological deficits.Brain magnetic resonance imaging shows asymmetric T2/fluid attenuated inversion recovery hyperintensity in cortical and subcortical white matter,in addition to multiple cerebral microbleeds.The disease often needs to be differentiated from primary angiitis of the central nervous system,glioma,and varicella-zoster virus encephalitis.Although the disease is rare,prompt treatment with glucocorticoids and immune suppressants can reduce death and disability and significantly improve outcome.Therefore,it is necessary to improve the ability of early diagnosis and treatment of this disease.