大腦類澱粉血管病變:高齡患者腦出血之常見原因：病例報告

大腦類澱粉血管病變是類澱粉沉積於大腦血管壁所引起的血管病變，常見於老年人，亦是引起廟顱內出血的重要原因之一。其出血部位常是在大腦皮層或皮層下，有別於高血壓造成之顱內出血。據文獻記載約有5%至10%的非外傷性顱丙出止是因大腦類澱粉血管病變所引起，但由於其確切診所須藉助於病理切片，所以易被忽略或被誤診為腫瘤出血等較罕見的原因。大腦類澱粉血管病變所引起的顱內出血易有再發性，對這類患者如何避兔其再出血乃是最重要的課題。本文報告一例大腦類澱粉血管病變造成顱內出血的患者，從影像診斷上被判定是顱內腫瘤出血，因而接受頭顱切開街以去除血腫及腦組織切片，但病理切片發現為大腦類澱粉血管病變。我們特別提出其臨床過程，並採計其鑑別診斷及爾後預防出血的原則，以供參考。

關鍵字

大腦類澱粉血管病變；腦出血；老化

並列摘要

Cerebral amyloid angiopathy, defined as deposition of amyloid in the walls of brain vessels, is belived to be a common cause of intracerebral hemorrhage in the elderly. It differentiates from the intracerebral hemorrhage of hypertension by its specific location of bleeding. The hematoma from cerebral amyloid angiopathy, sometimes multilobar, is always located in the brain cortices and the white matter beneath them. In the previous reports, the presence of cerebral amyloid angiopathy accounts for 5-10% of non-traumatic cerebral hemorrhage. However, it has been overlooked or misdiagnosed all the time because of the lack of tissue proof. Recurrent bleeding occurs so often, as it is rare in hypertensive intracerebral hemorrhage, that we should know how to detect cerebral amyloid angiopathy and prevent rebleeding. We report a case of intracerebral hemorrhage which was misdiagnosed as tumor bleeding. The patient underwent craniotomy for evacuation of hematoma and tumor excision. There was no tumor tissue in the specimen but it showed amyloid angiopathy. We presented her clinical course and discussed the differential diagnosis of intracerebral hemorrhage. We remind all the physiatrists that cerebral amyloid angiopathy is a possible cause of intracerebral hemorrhage, and not rare.

並列關鍵字

cerebral amyloid angiopathy ； intracerebral hemorrhage ； aging

國際替代計量

大腦類澱粉血管病變:高齡患者腦出血之常見原因：病例報告

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