帕金森病合并脑小血管病人脑组织病理学分析：附一例报告并文献复习

doi:10.3969/j.issn.1672-6731.2021.04.006

中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (4): 255-261. doi: 10.3969/j.issn.1672-6731.2021.04.006

• 神经病理与人脑组织库建设 • 上一篇下一篇

2 帕金森病合并脑小血管病人脑组织病理学分析：附一例报告并文献复习

曹凌晓¹, 董威¹, 李渊², 李少祥³, 陈彪², 黄越¹

1 100070 首都医科大学附属北京天坛医院神经病学中心国家神经系统疾病临床医学研究中心;
2 100053 北京, 首都医科大学宣武医院神经内科国家老年医学临床研究中心;
3 100070 首都医科大学附属北京天坛医院病理科

收稿日期:2021-04-07 出版日期:2021-04-25 发布日期:2021-04-27
通讯作者: 黄越,Email:yue.huang@ncrcnd.org.cn;陈彪,Email:pbchan@hotmail.com
基金资助:
国家自然科学基金资助项目（项目编号：82071417）

Brain pathological analysis of Parkinson's disease combined with cerebral small vessel disease: one case report and literature review

CAO Ling-xiao¹, DONG Wei¹, LI Yuan², LI Shao-xiang³, CHAN Piu², HUANG Yue¹

1 Center of Neurology, Beijing Tiantan Hospital, Capital Medical University;China National Clinical Research Center for Neurological Diseases, Beijing 100070, China;
2 Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University;National Center for Geriatrics Clinical Medicine Research, Beijing 100053, China;
3 Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2021-04-07 Online:2021-04-25 Published:2021-04-27
Supported by:
This study was supported by the National Natural Science Foundation of China (No. 82071417).

摘要/Abstract

摘要：

目的报道1例帕金森病合并脑小血管病人脑组织的病理学特点。方法与结果 男性患者，69岁，猝死后9.50小时由首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心人脑组织库完成脑组织捐献及接受工作。生前诊断为帕金森病，曾行脑深部电刺激术，但无脑小血管病的临床诊断。按照国际标准化脑库的脑组织处理流程，大体标本观察可见脑干黑质和蓝斑显著色素脱失，以及脑深部电刺激路径；组织病理学除帕金森病晚期（Braak分期Ⅴ期）病理表现外，还可见脑深部电刺激术后病理改变，以及额叶、颞叶、扣带回、基底节区和脑干等区域存在微小血管平滑肌细胞增生、管壁增厚变硬、玻璃样变、管腔狭窄，小血管周围间隙扩大，白质微梗死和小血管微出血的脑小血管病病理改变。最终病理诊断为帕金森病（Braak分期Ⅴ期），脑深部电刺激术后，脑小血管病。结论该例捐献者脑组织以帕金森病的临床诊断入库，病理证实除帕金森病和脑深部电刺激术后病理改变外，同时并存脑小血管病病理改变，提示应重视老年人群的多病共病。

关键词: 帕金森病, 深部脑刺激法, 大脑小血管疾病, 病理学, 人脑组织库(非MeSH词)

Abstract:

Objective To report on the pathological characteristics of brain tissue in a case of Parkinson's disease (PD) with cerebral small vessel disease (CSVD). Methods and Results The male patient, 69 years old, was suddenly died. His brain tissue was donated and accepted by the Human Brain Tissue Bank of China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 9.50 h after sudden death. The patient was diagnosed with PD, and had undergone deep brain stimulation (DBS), but there was no clinical diagnosis of CSVD. We processed the brain tissue according to standardized procedure of international brain banks. Gross observation showed there was significant discoloration in the substantia nigra and locus coeruleus. The DBS pathway was also visible. Microscopic observation showed in addition to advanced stage of PD (Braak stage Ⅴ), pathological changes of DBS could also be seen, as well as CSVD pathological changes such as microvascular smooth muscle cell proliferation, thickening and hardening vessel walls, hyaline degeneration, lumen stenosis, severe perivascular dilatation, white matter microinfarction and microhemorrhage in frontal lobe, temporal lobe, cingulate gyrus, basal ganglia, brainstem and other areas. The final pathological diagnosis was PD (Braak stage Ⅴ) after DBS and CSVD. Conclusions This brain tissue was enrolled into the brain bank for the clinical diagnosis of PD. Pathological examination showed that in addition to the pathological changes of PD and DBS, CSVD was also coexisted. This case suggests that attention should be paid to the multiple comorbidities of neurological diseases of the elderly.

Key words: Parkinson disease, Deep brain stimulation, Cerebral small vessel diseases, Pathology, Human brain bank (not in MeSH)

曹凌晓, 董威, 李渊, 李少祥, 陈彪, 黄越. 帕金森病合并脑小血管病人脑组织病理学分析：附一例报告并文献复习[J]. 中国现代神经疾病杂志, 2021, 21(4): 255-261.

CAO Ling-xiao, DONG Wei, LI Yuan, LI Shao-xiang, CHAN Piu, HUANG Yue. Brain pathological analysis of Parkinson's disease combined with cerebral small vessel disease: one case report and literature review[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(4): 255-261.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I4/255

参考文献

[1] Spillantini MG, Schmidt ML, Lee VM, Trojanowski JQ, Jakes R, Goedert M. Alpha-synuclein in Lewy bodies[J]. Nature, 1997, 388:839-840.
[2] Chojdak-?ukasiewicz J, Dziadkowiak E, Zimny A, Paradowski B. Cerebral small vessel disease:a review[J]. Adv Clin Exp Med, 2021, 30:349-356.
[3] Schwartz RS, Halliday GM, Cordato DJ, Kril JJ. Small-vessel disease in patients with Parkinson's disease:a clinicopathological study[J]. Mov Disord, 2012, 27:1506-1512.
[4] Bergkamp MI, Tuladhar AM, van der Holst HM, van Leijsen EMC, Ghafoorian M, van Uden IWM, van Dijk EJ, Norris DG, Platel B, Esselink RAJ, Leeuw FE. Brain atrophy and strategic lesion location increases risk of parkinsonism in cerebral small vessel disease[J]. Parkinsonism Relat Disord, 2019, 61:94-100.
[5] Wan Y, Hu W, Gan J, Song L, Wu N, Chen Y, Liu Z. Exploring the association between cerebral small-vessel diseases and motor symptoms in Parkinson's disease[J]. Brain Behav, 2019, 9:e01219.
[6] Park YW, Shin NY, Chung SJ, Kim J, Lim SM, Lee PH, Lee SK, Ahn KJ. Magnetic resonance imaging-visible perivascular spaces in basal ganglia predict cognitive decline in Parkinson's disease[J]. Mov Disord, 2019, 34:1672-1679.
[7] Vonsattel JP, Del Amaya MP, Keller CE. Twenty-first century brain banking. Processing brains for research:the Columbia University methods[J]. Acta Neuropathol, 2008, 115:509-532.
[8] Montine TJ, Phelps CH, Beach TG, Bigio EH, Cairns NJ, Dickson DW, Duyckaerts C, Frosch MP, Masliah E, Mirra SS, Nelson PT, Schneider JA, Thal DR, Trojanowski JQ, Vinters HV, Hyman BT; National Institute on Aging, Alzheimer's Association. National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease:a practical approach[J]. Acta Neuropathol, 2012, 123:1-11.
[9] Braak H, Braak E. Neuropathological stageing of Alzheimer-related changes[J]. Acta Neuropathol, 1991, 82:239-259.
[10] Braak H, Del Tredici K, Rüb U, de Vos RA, Jansen Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson's disease[J]. Neurobiol Aging, 2003, 24:197-211.
[11] Simon DK, Tanner CM, Brundin P. Parkinson disease epidemiology, pathology, genetics, and pathophysiology[J]. Clin Geriatr Med, 2020, 36:1-12.
[12] Alafuzoff I, Ince PG, Arzberger T, Al-Sarraj S, Bell J, Bodi I, Bogdanovic N, Bugiani O, Ferrer I, Gelpi E, Gentleman S, Giaccone G, Ironside JW, Kavantzas N, King A, Korkolopoulou P, Kovács GG, Meyronet D, Monoranu C, Parchi P, Parkkinen L, Patsouris E, Roggendorf W, Rozemuller A, Stadelmann-Nessler C, Streichenberger N, Thal DR, Kretzschmar H. Staging/typing of Lewy body related alpha-synuclein pathology:a study of the BrainNet Europe Consortium[J]. Acta Neuropathol, 2009, 117:635-652.
[13] Coughlin DG, Petrovitch H, White LR, Noorigian J, Masaki KH, Ross GW, Duda JE. Most cases with Lewy pathology in a population-based cohort adhere to the Braak progression pattern but ‘failure to fit’ is highly dependent on staging system applied[J]. Parkinsonism Relat Disord, 2019, 64:124-131.
[14] Dickson DW, Uchikado H, Fujishiro H, Tsuboi Y. Evidence in favor of Braak staging of Parkinson's disease[J]. Mov Disord, 2010, 25 Suppl 1:78-82.
[15] Kempster PA, O'Sullivan SS, Holton JL, Revesz T, Lees AJ. Relationships between age and late progression of Parkinson's disease:a clinico-pathological study[J]. Brain, 2010, 133(Pt 6):1755-1762.
[16] van de Berg WD, Hepp DH, Dijkstra AA, Rozemuller JA, Berendse HW, Foncke E. Patterns of α-synuclein pathology in incidental cases and clinical subtypes of Parkinson's disease[J]. Parkinsonism Relat Disord, 2012, 18 Suppl 1:28-30.
[17] Henderson JM, Pell M, O'Sullivan DJ, McCusker EA, Fung VS, Hedges P, Halliday GM. Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease[J]. Mov Disord, 2002, 17:133-137.
[18] Vedam-Mai V, Gardner B, Okun MS, Siebzehnrubl FA, Kam M, Aponso P, Steindler DA, Yachnis AT, Neal D, Oliver BU, Rath SJ, Faull RL, Reynolds BA, Curtis MA. Increased precursor cell proliferation after deep brain stimulation for Parkinson's disease:a human study[J]. PLoS One, 2014, 9:e88770.
[19] Pienaar IS, Lee CH, Elson JL, McGuinness L, Gentleman SM, Kalaria RN, Dexter DT. Deep-brain stimulation associates with improved microvascular integrity in the subthalamic nucleus in Parkinson's disease[J]. Neurobiol Dis, 2015, 74:392-405.
[20] Pal GD, Ouyang B, Serrano G, Shill HA, Goetz C, Stebbins G, Metman LV, Driver-Dunckley E, Mehta SH, Caviness JN, Sabbagh MN, Adler CH, Beach TG; Arizona Study of Aging Neurodegenerative Disorders. Comparison of neuropathology in Parkinson's disease subjects with and without deep brain stimulation[J]. Mov Disord, 2017, 32:274-277.
[21] Vedam-Mai V, Rodgers C, Gureck A, Vincent M, Ippolito G, Elkouzi A, Yachnis AT, Foote KD, Okun MS. Deep brain stimulation associated gliosis:a post-mortem study[J]. Parkinsonism Relat Disord, 2018, 54:51-55.
[22] Holanda VM, Okun MS, Middlebrooks EH, Gungor A, Barry ME, Forder J, Foote KD. Postmortem dissections of common targets for lesion and deep brain stimulation surgeries[J]. Neurosurgery, 2020, 86:860-872.
[23] Haberler C, Alesch F, Mazal PR, Pilz P, Jellinger K, Pinter MM, Hainfellner JA, Budka H. No tissue damage by chronic deep brain stimulation in Parkinson's disease[J]. Ann Neurol, 2000, 48:372-376.
[24] Vedam-Mai V, Baradaran-Shoraka M, Reynolds BA, Okun MS. Tissue response to deep brain stimulation and microlesion:a comparative study[J]. Neuromodulation, 2016, 19:451-458.
[25] Klioueva NM, Rademaker MC, Dexter DT, Al-Sarraj S, Seilhean D, Streichenberger N, Schmitz P, Bell JE, Ironside JW, Arzberger T, Huitinga I. BrainNet Europe's Code of Conduct for brain banking[J]. J Neural Transm (Vienna), 2015, 122:937-940.
[26] Kretzschmar H. Brain banking:opportunities, challenges and meaning for the future[J]. Nat Rev Neurosci, 2009, 10:70-78.

选择文件类型/文献管理软件名称

选择包含的内容

2 帕金森病合并脑小血管病人脑组织病理学分析：附一例报告并文献复习

Brain pathological analysis of Parkinson's disease combined with cerebral small vessel disease: one case report and literature review

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	范咏言, 李晓欢, 马建军, 杨大伟, 梁可可, 石小雪. 帕金森病患者血清胆红素与睡眠障碍相关分析[J]. 中国现代神经疾病杂志, 2023, 23(8): 723-729.
[2]	马晓丽, 童家杰, 张秀智, 杜倩, 隋爱霞, 赵焕芬. 表现为垂体腺瘤卒中的黄色瘤性垂体炎[J]. 中国现代神经疾病杂志, 2023, 23(7): 599-603.
[3]	侯玮佳, 于洋, 吴璠, 王玥, 朱志中, 巫嘉陵. 早期帕金森病患者起步异常定量分析[J]. 中国现代神经疾病杂志, 2023, 23(7): 627-632.
[4]	潘希娟, 邢英琦, 刘玉梅. 脑小血管病影像学评分方法[J]. 中国现代神经疾病杂志, 2023, 23(7): 633-637.
[5]	邵暇荔, 张泳, 金莉蓉, 王剑. 震颤为主型帕金森病与特发性震颤患者脑灌注对比分析[J]. 中国现代神经疾病杂志, 2023, 23(6): 542-548.
[6]	王敏, 秦洁, 李岚昕, 李欣, 陈蕾. 2型糖尿病增加帕金森病风险相关机制研究进展[J]. 中国现代神经疾病杂志, 2023, 23(6): 566-570.
[7]	王梦莹, 胡峰, 舒凯, 蔡宏斌, 康慧聪. 脑深部电刺激术治疗耐药性癫痫研究进展[J]. 中国现代神经疾病杂志, 2023, 23(3): 173-178.
[8]	李字林, 胡文瀚, 张凯. 癫痫外科常见病理类型体细胞突变研究进展[J]. 中国现代神经疾病杂志, 2023, 23(2): 115-123.
[9]	白雪冬, 张小雷, 夏爽. 深度学习在脑小血管病影像学标志物中的研究进展[J]. 中国现代神经疾病杂志, 2023, 23(1): 9-14.
[10]	刘培培, 巫嘉陵. 基于视频信息的帕金森病智能辅助诊断与治疗进展[J]. 中国现代神经疾病杂志, 2023, 23(1): 35-39.
[11]	王圆圆, 王鲁宁, 朱明伟. 病理性TDP-43蛋白在常见神经系统变性疾病患者杏仁核中的表达变化[J]. 中国现代神经疾病杂志, 2022, 22(9): 787-794.
[12]	菅凤增, 王兴文. 分子病理诊断时代脊柱脊髓肿瘤的诊断与治疗[J]. 中国现代神经疾病杂志, 2022, 22(8): 651-654.
[13]	姚庆宇, 马龙冰, 菅凤增. 脊髓空洞症大鼠模型长期稳定性评价[J]. 中国现代神经疾病杂志, 2022, 22(8): 662-668.
[14]	王军成, 赵岳阳, 马东明. 我国脑肿瘤专病人脑组织资源库建设意义及进展[J]. 中国现代神经疾病杂志, 2022, 22(7): 635-640.
[15]	刘子悦, 朱以诚. 脑小静脉与脑结构变化相关研究进展[J]. 中国现代神经疾病杂志, 2022, 22(6): 450-454.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 帕金森病合并脑小血管病人脑组织病理学分析：附一例报告并文献复习

Brain pathological analysis of Parkinson's disease combined with cerebral small vessel disease: one case report and literature review

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价