Hypertensive Cerebrovascular Disease

Epidemiology and Etiology:

· Intracerebral hemorrhage:

· HTN accounts for > 50% of clinically significant intracerebral hemorrhages

· Brain hemorrhage accounts for 15% of deaths among patients with chronic HTN

· Arteriolar walls affected by hyaline change are presumably weaker and more vulnerable to rupture

· Charcot-Bouchard microaneurysms may be the site of rupture

· Occur in vessels that are < 300 um in diameter

· Basal ganglia common site

· Lacunar infarcts:

· Occlusion of arterioles by hyalinosis

· Slit hemorrhages:

· Rupture of small-caliber penetrating vessels

Common sites:

· Intracerebral hemorrhage:

· Basal ganglia (ganglionic hemorrhage)

· Putamen (50-60%)

· Thalamus

· Pons

· Cerebellar hemispheres (rare) (lobar hemorrhage)

· Lacunar infarcts (decreasing order of frequency):

· Lenticular nucleus

· Thalamus

· Internal capsule

· Deep white matter

· Caudate nucleus

· pons

Gross features:

· Lacunar infarcts:

· Single or multiple

· Small cavitary infarcts

· < 15 mm

· Slit hemorrhages:

· Small hemorrhages -> resorb leaving a slit-like cavity surrounded by brown discolouration

· Acute hypertensive encephalopathy

· Edematous brain

· Herniations maybe

· Petichiae in gray and white matter

·

Histologic features:

· Lacunar infarcts:

· Cavities with scattered fat-laden macrophages and surrounding gliosis

· Slit hemorrhages:

· Focal tissue destruction

· Pigment-laden macrophages

· Gliosis

· Acute hypertensive encephalopathy

· Fibrinoid necrosis of arterioles in gray and white matter maybe

Immunophenotype:

Marker:

Sensitivity:

Specificity:

Molecular features:

·

Other features:

· Acute hypertensive encephalopathy

· Diffuse cerebral dysfunction

· Headaches

· Confusion

· Vomiting

· Convulsions

· Coma sometimes

· Vascular (multi-infarct) dementia

References:

· Kumar V, Fausto N, Abbas A. Robbins & Cotran Pathologic Basis of Disease, Seventh Edition. 7th ed. Saunders; 2004:1552.