Hypertensive microangiopathy, also referred to as chronic hypertensive encephalopathy, hypertensive arteriopathy, hypertensive arteriolosclerosis, and hypertensive small vessel disease, is a form of sporadic cerebral small vessel disease that results from the sustained effects of elevated systemic blood pressure on the brain. Both ischemic and hemorrhagic sequelae can result.
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Terminology
Chronic hypertensive encephalopathy should not be confused with other hypertension-related syndromes such as acute hypertensive encephalopathy and posterior reversible encephalopathy syndrome (PRES).
Radiographic features
MRI
Hypertensive microangiopathy features the following:
cerebral microhemorrhages predominantly in the deep grey nuclei and brain stem, and less commonly lobar sites
intracerebral hemorrhages (macrobleeds) predominantly in the deep grey nuclei and brain stem, and less commonly lobar sites
subcortical infarcts/lacunes in the deep grey nuclei, white matter, and brain stem
dilated perivascular spaces in the basal ganglia
T2 hyperintensities in the white matter as well as in the deep grey nuclei and brainstem
Differential diagnosis
There are a number of conditions to be considered:
cerebral microhemorrhages secondary to cerebral amyloid angiopathy peripherally distributed, in the same distribution as lobar hemorrhages
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multiple cavernous malformations as seen in familial multiple cavernous malformation syndrome
randomly distributed
some are larger
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calcified
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calcified/treated metastases
usually larger
more peripheral