Анналы клинической и экспериментальной неврологии (Feb 2017)
Predictors of massive intracerebral hemorrhages in arterial hypertension
Abstract
In 125 autopsies cases of massive intracerebral hemorrhages(ICH), caused by arterial hypertension (AH), retrospectiveclinical analysis and macro- and microscopic investigation ofbrain and its vascular system were conducted. There were 54females and 71 males aged from 21 to 75 (average age is5311). 78% of patients suffered from essential AH, 22% from nephrogenic AH. In 50% of cases duration of AH wasover 10 years. In 62% of cases the disease was severe, with uneffectivetreatment, and often hypertensive cerebral crises. Over30% of these patients suffered from strokes. In all cases brain analysis showed large ICHs (over 40 cm3), which in 84% ofcases were located in cerebral hemispheres (lateral ICHs 49%, mixed 38%, medial 13%), in brainstem 9%, and incerebellum 7%. In 79% of cases massive penetration of bloodinto ventricular system was noted. Macroscopic analysisrevealed local brain changes in 63% of all cases: 35% in theform of large post-haemorrhagic cysts, 44% in the form of asingle or multiple lacunar infarcts (LIs). In 38% of cases withmultiple LIs lacunar condition of brain was diagnosed. In 16%of these cases both cysts and multiple LIs were revealed. Localchanged were found in the same deep brain areas as ICHs:more often in basal ganglions and cerebral white matter, andless often in thalamus, pons and cerebellum. In microscopicexamination morphological changes characteristic of hypertensiveangioencephalopathy were detected: LIs, incompletenecrosis foci, white matter spongiosis, perivascularencephalolysis foci, criblurs, microhemorrhages. Examinationof hemorrhage foci revealed structural elements of LIs locatedon the edge and around hemorrhage. According to our data, wesuppose, that previous local and diffuse brain tissue changes,which are typical for hypertensive angioencephalopathy andlacunar condition, are predictors of massive ICHs.
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