过敏性血管炎合并脑卒中(附1例报告)

目的　探讨过敏性血管炎(hypersensitivity vasculitis,HSV)合并脑卒中患者的临床、病理和影像学特点及激素的疗效。方法　报导1例HSV合并脑卒中患者的临床、病理和影像学资料,观察激素治疗的疗效,随访其预后。结果　过敏性血管炎主要累及皮肤和关节,表现为皮肤隆起性紫癜,压之不退色,斑丘疹;关节疼痛、红肿热。皮肤外表现较少见,尤其反复急性脑损害极其罕见。皮肤活检病理特点为真皮小动脉、毛细血管和(或)小静脉有多核或单核白细胞浸润。血管壁纤维素样坏死,血管周围大量中性粒细胞浸润,白细胞破碎,红细胞外渗,管腔血栓形成。激素治疗能完全康复。随访数月无复发。结论　过敏性血管炎合并脑卒中可能是因过敏反应引起颅内微动脉、微静脉的反复血栓与出血所致,激素治疗有效,预后良好。

Hypersensitivity vasculitis with cerebral stroke

Objective To evaluate the clinical,pathological,neuroimaging features of patients with hypersensitivity vasculitis and cerebral stroke and its respondence to the treatment with corticosteroids.Methods:We report on a case of HSV and cerebral stroke,provide the data of its clinical features,pathology and iconography,observe its respondence to corticosteroids,approach to monitor its prognosis.Result HSV is mainly involved in skin and the joint,is characterized by palpable purpura which doesn't fade after prossed,maculopapular rashes,arthralgia and redness,swelling,heat of the joint.The manifestations out of the cutaneous are rare,especially the repeated acute brain involvement.The skin biopsy demonstrated the pathological features which are characterized by the infiltrating polynuclear or momonuclear leukocytes in the arterioles,capillaries and(or) venules of dermis,fibroid necrosis of the vessel walls,massive neutrophils infiltrated around the vessels,leucocytoclast,exudation of erythrocytes and the luminal thrombogenesis.The patient is curative after the treatment with hormone.No recurrence after a follow-up of several months.Conclusion Hypersensitivity vasculitis complicated with cerebral stroke may results from the allergic reaction which induces the repeated embolism and bleeding of the intracranial arterioles and venules.The treatment with corticosteroids is effective and prognosis is excellent.