Brain pathological analysis of Parkinson's disease combined with cerebral small vessel disease: one case report and literature review

Abstract

Objective To report on the pathological characteristics of brain tissue in a case of Parkinson's disease (PD) with cerebral small vessel disease (CSVD). Methods and Results The male patient, 69 years old, was suddenly died. His brain tissue was donated and accepted by the Human Brain Tissue Bank of China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 9.50 h after sudden death. The patient was diagnosed with PD, and had undergone deep brain stimulation (DBS), but there was no clinical diagnosis of CSVD. We processed the brain tissue according to standardized procedure of international brain banks. Gross observation showed there was significant discoloration in the substantia nigra and locus coeruleus. The DBS pathway was also visible. Microscopic observation showed in addition to advanced stage of PD (Braak stage Ⅴ), pathological changes of DBS could also be seen, as well as CSVD pathological changes such as microvascular smooth muscle cell proliferation, thickening and hardening vessel walls, hyaline degeneration, lumen stenosis, severe perivascular dilatation, white matter microinfarction and microhemorrhage in frontal lobe, temporal

lobe, cingulate gyrus, basal ganglia, brainstem and other areas. The final pathological diagnosis was PD (Braak stage Ⅴ) after DBS and CSVD. Conclusions This brain tissue was enrolled into the brain bank for the clinical diagnosis of PD. Pathological examination showed that in addition to the pathological changes of PD and DBS, CSVD was also coexisted. This case suggests that attention should be paid to the multiple comorbidities of neurological diseases of the elderly.

doi：10.3969/j.issn.1672⁃6731.2021.04.006