Microscopic neuroanatomic abnormalities in autism.
Microscopic neuroanatomic abnormalities in autism.
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DOI：
10.1542/peds.87.5.791
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发表时间：
1991-05
期刊：
影响因子：
8
通讯作者：
Margaret L. Bauman
中科院分区：
文献类型：
--
作者：
Margaret L. Bauman
自1943年首次被描述以来，自闭症主要被定义为一种行为障碍，多年来，它被认为是父母和环境影响的结果。然而，随着临床对这种疾病的兴趣的提高，与医学技术的进步相一致，自闭症的潜在神经学基础的证据越来越明显。历史的神经病理学观点基于表征自闭症的一系列症状，大脑内的不同解剖部位被认为可能是自闭症病理的主要来源。怀疑的区域包括内侧颞叶，2-5丘脑核，6基底神经节，7和前庭系统计算机断层成像研究显示了不一致的结果。然而，最近的磁共振成像研究已经描述了小脑和后窝部分的异常。直到最近，对自闭症患者的大脑进行直接显微镜检查所得的信息还很少。Aarkrog18报道，在对一名自闭症患者进行的额叶活检中，“小动脉轻微增厚，轻脑膜轻微结缔组织增加，一些细胞增加”。后来，在1976年，darby回顾了33例儿童精神病病例。19尽管他提出边缘系统病变与自闭症的情感症状之间可能存在相关性，但没有发现一致的神经病理学结果。1980年，Williams等人研究了4名有自闭症样行为的患者的大脑切片；他们主要寻找细胞丢失和神经胶质瘤，但未能发现任何一致的异常。显微镜下的神经解剖学观察1984年，一名29岁的自闭症患者的大脑出现了解剖异常；采用全脑连续切片技术，并将患者与年龄和性别匹配的相同处理的对照受试者进行比较
Since its initial description in 1943,1 autism has been primarily conceptualized as a behavioral disorder, and for many years it was believed to be the result of parental and environmental influences. With heightened clinical interest in the disorder, coincident with advances in medical technology, however, evidence for an underlying neurologic basis for autism has become increasingly apparent. HISTORICAL NEUROPATHOLOGIC PERSPECTIVE Based largely on the constellation of symptoms that characterize the disorder, various anatomical sites within the brain have been suggested as a possible primary source of pathology in autism. Suspected regions have included the medial temporal lobe,2-5 the thalamic nuclei,6 the basal ganglia,7 and the vestibular system.8 Computed tomographic imaging studies have shown inconsistent findings.9-14 More recently, however, magnetic resonance imaging studies have described abnormalities in portions of the cerebellum and posterior fossa.15-17 Direct microscopic examination of the autistic brain has, until recently, yielded little information. Aarkrog18 reported "slight thickening of the arterioles, slight connective tissue increase in the leptomeninges, and some cell increase" in a frontal lobe biopsy performed on an autistic patient. Later, in 1976, 33 cases of childhood psychosis were reviewed by Darby.19 Although he suggested a possible correlation between limbic system lesions and the affective symptomatology of autism, no consistent neuropathologic findings were found. In 1980, Williams et al20 studied sections of brain from four patients with autistic-like behavior; looking primarily for cell loss and gliosis, they failed to find any consistent abnormalities. MICROSCOPIC NEUROANATOMIC OBSERVATIONS In 1984, anatomic abnormalities were reported in the brain of a 29-year-old man with well-documented autism; the technique of whole brain serial section was used, and the patient was studied in comparison with an identically processed age- and sex-matched control subject.21,22