Hypertensive microangiopathy
Updates to Article Attributes
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, leading to lipohyalinosisCharcot-Bouchard aneurysms that are in turn prone to rupture resulting in hypertensive intracerebral haemorrhages
Terminology
The terms hypertensive microangiopathy and chronicChronic hypertensive encephalopathy are not used uniformly in the literature but should probably be considered distinct from chronic small vessel disease despite hypertension being an important risk factor for it also. The latter is dominated by white matter change (leukoaraiosis) but does not necessarily have microhaemorrhages.
Additionally, chronic hypertensive encephalopathy should not be confused with acute hypertensive encephalopathy -, better known as posterior reversible encephalopathy syndrome (PRES).
Radiographic features
MRI
The key finding of hypertensiveHypertensive microangiopathy isfeatures the presence of microhaemorrhages affectingfollowing:
cerebral microbleeds predominantly in the
basal ganglia,ponscerebellar hemispheres1. This isnot surprisingly, the same distribution as macroscopichypertensiveand less commonly lobar sitesintracerebral haemorrhages
.(macrobleeds) predominantly in the deep grey nuclei and brain stem, and less commonly lobar sitesThese are best seensubcortical infarcts/lacunes in the deep grey nuclei, white matter, and brain stemdilated perivascular spaces in the basal ganglia
white matter hyperintensities as well as hyperintensities in the deep grey nuclei and brainstem on
T2* sequences, particularlysusceptibility-weighted imaging (SWI)as small blooming areas of signal loss1.
Differential diagnosis
There are a number of conditions to be considered:
microhaemorrhages secondary to cerebral amyloid angiopathy peripherally distributed, in the same distribution as lobar haemorrhages
-
multiple cavernous malformations as seen in familial multiple cavernous malformation syndrome
randomly distributed
some are larger
-
calcified
-
calcified/treated metastases
usually larger
more peripheral
-<p><strong>Hypertensive microangiopathy</strong>, also referred to as <strong>chronic hypertensive encephalopathy</strong>, results from the sustained effects of elevated systemic blood pressure on the brain, leading to <a href="/articles/lipohyalinosis">lipohyalinosis</a> and <a href="/articles/charcot-bouchard-aneurysm">Charcot-Bouchard aneurysms</a> that are in turn prone to rupture resulting in <a href="/articles/hypertensive-intracerebral-haemorrhage">hypertensive intracerebral haemorrhages</a>. </p><h4>Terminology</h4><p>The terms <strong>hypertensive microangiopathy</strong> and <strong>chronic hypertensive encephalopathy</strong> are not used uniformly in the literature but should probably be considered distinct from <a href="/articles/cerebral-small-vessel-disease">chronic small vessel disease</a> despite hypertension being an important risk factor for it also. The latter is dominated by white matter change (leukoaraiosis) but does not necessarily have microhaemorrhages. </p><p>Additionally, <strong>chronic hypertensive encephalopathy</strong> should not be confused with <a href="/articles/acute-hypertensive-encephalopathy">acute hypertensive encephalopathy</a> - better known as <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome (PRES)</a>.</p><h4>Radiographic features</h4><h5>MRI</h5><p>The key finding of hypertensive microangiopathy is the presence of microhaemorrhages affecting the <a href="/articles/basal-ganglia">basal ganglia</a>, <a href="/articles/pons">pons</a> and <a href="/articles/cerebellum-anatomy">cerebellar hemispheres</a> <sup>1</sup>. This is, not surprisingly, the same distribution as macroscopic <a href="/articles/hypertensive-intracerebral-haemorrhage">hypertensive intracerebral haemorrhages</a>.</p><p>These are best seen on T2* sequences, particularly <a href="/articles/susceptibility-weighted-imaging-1">susceptibility-weighted imaging (SWI)</a> as small blooming areas of signal loss <sup>1</sup>.</p><h4>Differential diagnosis</h4><p>There are a number of conditions to be considered:</p><ul>- +<p><strong>Hypertensive microangiopathy</strong>, also referred to as <strong>chronic hypertensive encephalopathy</strong>,<strong> hypertensive arteriopathy</strong>,<strong> hypertensive arteriolosclerosis</strong>,<strong> </strong>and <strong>hypertensive small vessel disease</strong>, is a form of sporadic <a href="/articles/cerebral-small-vessel-disease" title="Cerebral small vessel disease">cerebral small vessel disease</a> that results from the sustained effects of elevated systemic blood pressure on the brain. Both ischaemic and haemorrhagic sequelae can result.</p><h4>Terminology</h4><p>Chronic hypertensive encephalopathy should not be confused with acute hypertensive encephalopathy, better known as <a href="/articles/posterior-reversible-encephalopathy-syndrome-1">posterior reversible encephalopathy syndrome (PRES)</a>.</p><h4>Radiographic features</h4><h5>MRI</h5><p>Hypertensive microangiopathy features the following:</p><ul>
- +<li><p><a href="/articles/cerebral-microhaemorrhage" title="Cerebral microbleeds">cerebral microbleeds</a> predominantly in the deep grey nuclei and brain stem, and less commonly lobar sites</p></li>
- +<li><p><a href="/articles/hypertensive-intracerebral-haemorrhage" title="Hypertensive intracerebral hemorrhage">intracerebral haemorrhages</a> (macrobleeds) predominantly in the deep grey nuclei and brain stem, and less commonly lobar sites</p></li>
- +<li><p>subcortical infarcts/<a href="/articles/lacunar-infarct" title="Lacunar infarct">lacunes</a> in the deep grey nuclei, white matter, and brain stem</p></li>
- +<li><p>dilated <a href="/articles/perivascular-spaces" title="Perivascular spaces">perivascular spaces</a> in the basal ganglia</p></li>
- +<li><p>white matter hyperintensities as well as hyperintensities in the deep grey nuclei and brainstem on T2WI</p></li>
- +</ul><h4>Differential diagnosis</h4><p>There are a number of conditions to be considered:</p><ul>
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