Hypertensive intracerebral hemorrhage

Hypertensive intracerebral hemorrhages are common. In fact, hypertension is the most common cause of intracerebral hemorrhages. They can be conveniently divided according to their typical locations which include, in order of frequency: 

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 hemorrhages
      • 80% lenticulostriate
      • 10% pons
      • 10% cerebellum
    • found in hypertensive patients
    • may thrombose, leak (see cerebral microhemorrhages) or rupture 2
  • accelerated atherosclerosis: affects larger vessels
  • hyaline arteriosclerosis
  • hyperplastic arteriosclerosis: seen in very elevated and protracted cases

Stroke and intracranial haemorrhage
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Article information

rID: 13413
Synonyms or Alternate Spellings:
  • Hypertensive intracerebral haemorrhages
  • Hypertensive intracerebral hemorrhage
  • Hypertensive intracerebral hemorrhages
  • Hypertensive intracerebral bleed
  • Hypertensive intracranial bleed

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Cases and figures

  • Figure 1: Charcot Bouchard aneurysms
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  • Case 1: basal ganglia hemorrhage
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  • Case 2: pontine hemorrhage
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  • Case 3: cerebellar hemorrhage
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  • Case 4: periventricular hemorrhage
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  • Case 5: thalamic hemorrhage
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  • Case 6: cerebellar hemorrhage
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  • Case 7: combined traumatic and hypertensive hemorrhage
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  • Case 8: combined pontine and basal ganglia hemorrhages
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