Human cerebral infarct: a proposed histopathologic classification based on 137 cases
Human cerebral infarct: a proposed histopathologic classification based on 137 cases
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DOI：
10.1007/s00401-004-0918-z
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发表时间：
2004-12-01
影响因子：
12.7
通讯作者：
Rushing, EJ
中科院分区：
文献类型：
--
作者：
Mena, H;Cadavid, D;Rushing, EJ
我们研究了137例人脑梗死的显微特征。在每个病例中，通过测量从最初临床表现到手术或死亡日期之间的时间来确定病变的年龄。对苏木精染色和伊红染色切片进行多种显微变量分析。男性104例（76%），女性33例（24%），中位年龄64岁。脑梗死129例，小脑梗死5例，脑桥、中脑、髓质各1例。病变的年龄从1天到53岁不等。所有病变都是单一的，从一个或多个脑动脉分布的凹窝到大梗死不等。所提出的分类的主要组织学特征如下：(1)急性神经元损伤的阶段（研究的11例），年龄1-2天，特征是存在神经元改变，神经海绵症，无神经元铁化，慢性炎症，巨噬细胞，新血管形成和空化；(2)组织分期分为：(a)急性炎症期（31例），年龄3 ~ 37天，以凝固性坏死为特征，急性炎症多发；(b)慢性炎症期（57例），年龄10 ~ 53岁，以有无凝固性坏死、神经元损伤、红色神经元、巨噬细胞、单核炎性细胞、血管周围弯曲、空化、胶质细胞、球状体为特征；无中性粒细胞；(3)吸收期（38例），年龄26天-23岁，无炎症反应。神经吞噬不是脑梗死的特征。
We studied the microscopic features of 137 cases of human cerebral infarct. In each case, the age of the lesion was determined by measuring the time elapsed between initial clinical presentation and date of surgery or death. Multiple microscopic variables were analyzed on hematoxylin and eosin-stained sections. There were 104 (76%) male and 33 (24%) female patients with a median age of 64 years. The location of the infarcts included 129 cerebral, 5 cerebellar, and 1 each in the pons, midbrain and medulla. The age of the lesions ranged from 1 day to 53 years. All lesions were single and varied from lacunes to large infarcts in the distribution of one or more cerebral arteries. Key histologic features of the proposed classification are as follows: (1) phase of acute neuronal injury (11 cases studied), age 1-2 days, characterized by the presence of neuronal changes, and spongiosis of the neuropil and absence of neuronal ferrugination, chronic inflammation, macrophages, neo-vascularization and cavitation; (2) phase of organization subdivided into: (a) phase of acute inflammation (31 cases), age 3-37 days, characterized by coagulative necrosis, and frequent acute inflammation, and (b) phase of chronic inflammation (57 cases), age 10-days-53-years, characterized by the presence or absence of coagulative necrosis, neuronal injury, red neurons, macrophages, mononuclear inflammatory cells, perivascular cuffing, cavitation, gliosis, spheroids; absence of neutrophils; and (3) phase of resorption (38 cases), age 26-days-23-years, characterized by absence of an inflammatory response. Neuronophagia is not a feature of cerebral infarcts.