Arterial dissections of penetrating cerebral arteries causing hypertension-induced cerebral hemorrhage

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Object. For the past 130 years, it has been believed that hypertension-induced cerebral hemorrhages are the result of ruptures of microaneurysms or ruptures of arteries that have degenerative changes. The majority of previous investigations have focused on autopsied brain. In this study, the authors attempted to verify the cause of hypertension-induced cerebral hemorrhage by using surgical specimens of the penetrating arteries responsible for the hemorrhages.

Methods. Between 1997 and 1999, the authors performed pathological studies in surgical specimens of lenticulostriate arteries that had been confirmed during microsurgery to be the cause of hypertension-induced hemorrhage of the putamen. Nineteen lenticulostriate arteries were collected from 12 patients. Fifteen of these arteries were verified as the pathological causes of hemorrhage. They included six arterial dissections, six arterial ruptures with substantial degenerative changes, and three arterial ruptures with few degenerative changes. The pathological findings in the lenticulostriate artery dissections were similar to those of typical arterial dissections in major cerebral arteries.

Conclusions. To the best of the authors' knowledge, arterial dissections of lenticulostriate arteries have not been identified as a cause of hypertension-induced cerebral hemorrhages. When penetrating arteries are included as causative vessels, cerebral arterial dissections may be much more common than previously thought.

Article Information

Address reprint requests to: Tohru Mizutani, M.D., Department of Neurosurgery, Tokyo Metropolitan Fuchu Hospital, 2–9–2 Musasidai, Fuchu City, Tokyo 183–8524, Japan. email: mizutani@fuchu-hp.fuchu.tokyo.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photomicrographs (upper and center) and illustration (lower) showing arterial dissection. Upper: The IEL is disrupted (arrow) and a pseudolumen (P) is formed between the media and adventitia. Elastica van Gieson, original magnification × 100. Center: An arterial slice obtained near the end of an arterial dissection. A pseudolumen is communicating with the true lumen through the disrupted IEL (arrow). Movat pentachrome, original magnification × 100. Lower: Illustration of an arterial dissection in a perforating artery.

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    Photomicrographs demonstrating the various types of perforating arteries. Upper: Rupture of an artery with severe degenerative changes. The IEL is almost missing. Center: Rupture of an artery with pseudoaneurysm formation (arrow). Lower: Rupture of an artery with few degenerative changes. Elastica van Gieson, original magnification × 400.

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