Hypertensive intracerebral haemorrhage
Hypertensive intracerebral haemorrhages are common. In fact hypertension is the most common cause of intracerebral haemorrhages. They can be conveniently divided according to their typical locations which include, in order of frequency:
- basal ganglia haemorrhage (especially the putamen)
- thalamic haemorrhage
- pontine haemorrhage
- cerebellar haemorrhage
Pathology
Long standing poorly controlled hypertension leads to a variety of pathological changes in the vessels.
- microaneurysms of perforating arteries (Charcot-Bouchard aneurysms)
- small (0.3-0.9 mm) diameter
- occur on small (0.1-0.3 mm) diameter arteries
- distribution which matches incidence of hypertensive haemorrhages
- 80% lenticulostriate
- 10% pons
- 10% cerebellum
- found in hypertensive patients
- may thrombose, leak (see cerebral microhaemorrhages) or rupture 2
- accelerated atherosclerosis: affects larger vessels
- hyaline arteriosclerosis
- hyperplastic arteriosclerosis: seen in very elevated and protracted cases
Related articles
Stroke and intracranial haemorrhage
-
stroke and intracranial haemorrhage
-
ischaemic stroke
- general discussions
- scoring and classification systems
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- internal capsule infarct
- ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
- lacunar infarct
- thalamic infarct
- thalamic pain syndrome (Dejerine-Roussy syndrome): thalmoperforators of PCA
- top of the basilar syndrome
- cerebellar infarct
-
brainstem infarct
-
midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Weber syndrome: PCA
-
pontine infarct
- facial colliculus syndrome
- inferior medial pontine stroke syndrome (Foville syndrome): basilar artery
- lateral pontine stroke syndrome (Marie-Foix syndrome): basilar artery or AICA
- Millard-Gubler syndrome: basilar artery
- locked in syndrome: basilar artery
- Raymond syndrome: basilar artery
-
medullary infarct
- lateral medullary stroke syndrome (Wallenberg syndrome)
- hemimedullary syndrome (Babinski-Nageotte syndrome)
- medial medullary syndrome (Dejerine syndrome)
-
midbrain infarct
- acute spinal cord ischaemia syndrome
- hemispheric infarcts
- by vascular territory
-
intracranial haemorrhage
-
intra-axial haemorrhage
- basal ganglia haemorrhage
- cerebellar haemorrhage
- cerebral contusions
- CTA spot sign
- haemorrhagic venous infarct
- haemorrhagic transformation of an ischaemic infarct
- hypertensive intracranial haemorrhage
- intraventricular haemorrhage (IVH)
- lobar haemorrhage
- pontine haemorrhage
- remote cerebellar haemorrhage
- extra-axial haemorrhage
-
intra-axial haemorrhage
-
ischaemic stroke
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