Lacunar infarction and small vessel disease: pathology and pathophysiology.
Lacunar infarction and small vessel disease: pathology and pathophysiology.
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DOI：
10.5853/jos.2015.17.1.2
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发表时间：
2015-01
影响因子：
8.2
通讯作者：
Caplan LR
中科院分区：
文献类型：
--
作者：
Caplan LR
两种主要的血管病理学是患有小尺寸穿通脑动脉和小动脉疾病的患者的脑损伤的基础; 1）动脉中膜增厚和2）载瘤动脉内膜斑块阻塞穿通动脉的起源。这些小血管的中膜可能因纤维素样沉积和平滑肌及其他结缔组织成分肥大而增厚，伴随高血压和/或糖尿病患者的退行性变化，或可能含有异物沉积物，如淀粉样血管病和遗传介导的疾病，如伴有皮质下梗死和白质脑病的常染色体显性脑动脉病。这些病理变化导致2种不同的病理生理学：1）受影响动脉供血区域的脑缺血。结果是深部小梗死，最常累及基底节、脑桥、丘脑和大脑白色物质。和2）液体渗漏导致水肿和随后的白色物质束中的胶质增生。中膜和外膜的变化影响血管基质内的金属蛋白酶和其他物质，并导致这些小血管中的异常血/脑屏障。以及慢性胶质增生和大脑白色物质萎缩。
Two major vascular pathologies underlie brain damage in patients with disease of small size penetrating brain arteries and arterioles; 1) thickening of the arterial media and 2) obstruction of the origins of penetrating arteries by parent artery intimal plaques. The media of these small vessels may be thickened by fibrinoid deposition and hypertrophy of smooth muscle and other connective tissue elements that accompanies degenerative changes in patients with hypertension and or diabetes or can contain foreign deposits as in amyloid angiopathy and genetically mediated conditions such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. These pathological changes lead to 2 different pathophysiologies: 1) brain ischemia in regions supplied by the affected arteries. The resultant lesions are deep small infarcts, most often involving the basal ganglia, pons, thalami and cerebral white matter. And 2) leakage of fluid causing edema and later gliosis in white matter tracts. The changes in the media and adventitia effect metalloproteinases and other substances within the matrix of the vessels and lead to abnormal blood/brain barriers in these small vessels. and chronic gliosis and atrophy of cerebral white matter.
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影响因子：
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