Morphological changes in the brain in diabetic encephalopathy
Background. The purpose of this work was to study the morphological characteristics of brain changes in patients with diabetic encephalopathy (DE) on the basis of autopsy material research. Materials and methods. The paper presents the results of 14 postmortem observations. The mean age of the patients was 51.0 ± 3.4 years. The pieces of the brain were fixed in a solution of IHC Zinc Fixative, serial paraffin sections were made with a thickness of 10 ± 1 μm. The preparations were stained with hematoxylin and eosin, Congo red, thionin according to the Nissl method, Schick test was applied, with silver nitrate impregnation according to the Bielschowsky method and gold chloride — by Cajal, morphometric examination was performed according to G.G. Avtandilov. The study of the preparations was carried out on the Olympus AX70 microscope with a digital camera Olympus DP50. Microphotography of the preparations was performed using the program Pro 3.2. Results. The main cyto-angioarchitectonic manifestations of DE are: diffuse alteration of basal membranes and vascular endothelium of the microcirculatory bed, and to a lesser extent — arterioles, intracerebral arteries and veins. High density (specific volume) of the capillary network at DE morphologically reflects the pattern of capillary paralytic stagnation. Capillary stagnation is accompanied by a stasis of the blood, an increase in the perivascular capillary space (Virchow-Robin space), the width of which is the morphological equivalent of lymphatic dyscirculation. Early morphological damage to the capillary walls is thickening and cleft of the main membrane with the accumulation of Schick-positive substances, focal proliferation of endotheliocytes. Late injuries include capillary fibrosis and hyalinosis, proliferation of pericytes, which is accompanied by a sharp violation of transcapillary transport. Violation of striatal and radial cytoarchitectonics in the I–IV layers of the brain, prolapse of neurons (neuronal depopulation) is manifested by focal prolapse of ganglionic and pyramidal cells. Conclusions. Early reversible morphological changes of neurons are neuronal swelling (hydrophonic degeneration of nerve cells), focal hyperchromatosis. Irreversible structural damage to neurons is the lysis of the nucleus and nucleolus with homogenization of the cytoplasm, formation of shadow cells, vacuolization of the cytoplasm, pericellular edema, lysis of the processes in combination with neurophagia. The combination of acute alternative damage to neurons with chronic (ischemic) ones — pycnosis is typical, as well as coring of nuclei with pronounced atrophy of the cytoplasm.
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