Charcot-Bouchard aneurysms are thought to be minute aneurysms which develop along perforating arteries as a result of chronic hypertension, most commonly in the basal ganglia and other areas such as the thalamus, pons and cerebellum. They are believed to be the source of hypertensive hemorrhages.
Charcot-Bouchard aneurysms are thought to be the result of lipohyalinosis as of small penetrating vessels (diameter <300 micrometers) secondary to chronic poorly controlled hypertension 1-3. This results in vessels with a defect in the muscular coat and only a thin intimal layer with some surrounding gliosis 3. Thus, Charcot-Bouchard aneurysms are prone to rupture, with the inability to control bleeding by vasomotor spasm 3.
They have, however, proven difficult to fully characterize and some authors have even cast doubt upon their very existence suggesting, instead, that they represent artefacts due to vessel tortuosity 6,7. Still others have suggested that they represent pseudoaneurysms which sometimes have been referred to as hemostatic globes, fibrin globes or bleeding globes 8.
Not only is there controversy over the nature and very existence of Charcot-Bouchard aneurysms but their incidence and whether or not they actually are the cause of hemorrhage is also disputed 8.
In any event, they should not be confused with saccular aneurysms found in larger intracranial vessels in the subarachnoid space 1,4.
History and etymology
These small parenchymal microaneurysms were first described in 1868 by Jean-Martin Charcot (1825-1893) and Charles-Joseph Bouchard (1837--1915) both French pathologists 5.
- 1. Kumar, Abbas, Aster. Robbins and Cotran Pathologic Basis of Disease. 9th Edition. Chapter 28 - The Central Nervous System. Elsevier Saunders. 2015. Page 1268.
- 2. Gates P. Clinical Neurology: A Primer. Churchill Livingstone Elsevier Australia. 2010. Chapter 10 - Cerebrovascular Disease. Page 208-209.
- 3. Pryse-Phillips W. Companion to Clinical Neurology. 2nd Edition. Oxford University Press. 2003.
- 4. Kandel et al. Principles of Neural Science. 5th Edition. McGraw-Hill. 2013. Appendices C - Circulation of the Brain. Page 1563.
- 5. Charcot JM, Bouchard C. Nouvelle recherches sur la pathogenie de l’hemorrhagie cerebrale. Arch Physiol Norm Pathol. 1868; 1: 643–645
- 6. Challa, Venkat R., Moody, Dixon M., Bell, Mary A.. The Charcôt-Bouchard Aneurysm Controversy: Impact of a New Histologic Technique. (1992) Journal of Neuropathology & Experimental Neurology. 51 (3): 264. doi:10.1097/00005072-199205000-00004 - Pubmed
- 7. Spangler, Kevin M., Challa, Venkat R., Moody, Dixon M., Bell, Mary A.. Arteriolar Tortuosity of the White Matter in Aging and Hypertension. A Microradiographic Study. (1994) Journal of Neuropathology & Experimental Neurology. 53 (1): 22. doi:10.1097/00005072-199401000-00003 - Pubmed
- 8. Fibrinoid necrosis of small brain arteries and arterioles and miliary aneurysms as causes of hypertensive hemorrhage: a critical reappraisal. (2008) Acta Neuropathologica. 116 (4): 361. doi:10.1007/s00401-008-0416-9 - Pubmed