Cases of amyloidosis with diabetic encephalopathy

Abstract

Basic clinical manifestations of diabetic encephalopathy in pre-stroke and stroke stages in the elderly are considered. Psychometrical tests (Shulte tables of and Mini Mental Score Examination scale) were used to reveal cognitive impairments, which are markers of diabetic encephalopathy progression. The case of intravital visualization of diabetic cerebral angiopathy using magnetic resonance imaging in susceptibility weighted imaging mode was described in detail. And the case of amyloidosis confirmed by kidney biopsy material coloring with Congo Red. The results of immunological examination are given, proving a high rate of Interleukin-1 production - initiator of serum amyloid A synthesis in liver (serum amyloid A). Histories of lethal cases and pathohystological analysis results of ultrathin sections, obtained by the means of cerebrum autopsy with Congo Red coloring, were investigated. Autopsy materials with positive qualitative reaction on amyloid were taken for further analyzing in polarizing light and amyloid typing. AA-amyloid was discovered in all cases. Morphologic characteristic of diabetic encephalopathy was revealed using coloring by hematoxylin, eosin and Van Gieson’s stain: angioedema, microhemorrhagia, leukoaraiosis, gliomatosis and atrophy of neurons. Case of genetic polyorganic AA- amyloidosis, not diagnosed intravital, was described in detail. It was established that impaired protein metabolism with its final conformation in toxic amyloid components of tissues is an early and fairly frequent manifestation of diabetic encephalopathy metabolic disorders. The substantiated opinion, implying the necessity of deep protein metabolism investigation in cases of diabetes complicated with encephalopathy and amyloidosis, is given. The term «diabetic amyloid encephalopathy» is offered to include in diabetic encephalopathy classification.