In 125 autopsies cases of massive intracerebral hemorrhages (ICH), caused by arterial hypertension (AH), retrospective clinical analysis and macro- and microscopic investigation of brain and its vascular system were conducted. There were 54 females and 71 males aged from 21 to 75 (average age is 53±11). 78% of patients suffered from essential AH, 22% – from nephrogenic AH. In 50% of cases duration of AH was over 10 years. In 62% of cases the disease was severe, with uneffective treatment, and often hypertensive cerebral crises. Over 30% of these patients suffered from strokes. In all cases brain analysis showed large ICHs (over 40 cm3), which in 84% of cases were located in cerebral hemispheres (lateral ICHs – 49%, mixed – 38%, medial – 13%), in brainstem – 9%, and in cerebellum – 7%. In 79% of cases massive penetration of blood into ventricular system was noted. Macroscopic analysis revealed local brain changes in 63% of all cases: 35% in the form of large post-haemorrhagic cysts, 44% in the form of a single or multiple lacunar infarcts (LIs). In 38% of cases with multiple LIs lacunar condition of brain was diagnosed. In 16% of these cases both cysts and multiple LIs were revealed. Local changed were found in the same deep brain areas as ICHs: more often in basal ganglions and cerebral white matter, and less often – in thalamus, pons and cerebellum. In microscopic examination morphological changes characteristic of hypertensive angioencephalopathy were detected: LIs, incomplete necrosis foci, white matter spongiosis, perivascular encephalolysis foci, criblurs, microhemorrhages. Examination of hemorrhage foci revealed structural elements of LIs located on the edge and around hemorrhage. According to our data, we suppose, that previous local and diffuse brain tissue changes, which are typical for hypertensive angioencephalopathy and lacunar condition, are predictors of massive ICHs.
Predictors of massive intracerebral hemorrhages in arterial hypertension
- Authors: Gulevskaya T.S.1, Maksimova M.Y.1, Romanova A.V.1
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Affiliations:
- Research Center of Neurology
- Issue: Vol 7, No 3 (2013)
- Pages: 17-25
- Section: Original articles
- Submitted: 02.02.2017
- Published: 09.02.2017
- URL: https://annaly-nevrologii.com/journal/pathID/article/view/231
- DOI: https://doi.org/10.17816/psaic231
- ID: 231
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About the authors
Tat'yana S. Gulevskaya
Research Center of Neurology
Email: ncnmaximova@mail.ru
Russian Federation, Moscow
Marina Yu. Maksimova
Research Center of Neurology
Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-7682-6672
D. Sci. (Med), Prof., Head, 2nd Neurology department; professor, Division of diseases of the nervous system, Department of dentistry
Russian Federation, MoscowA. V. Romanova
Research Center of Neurology
Author for correspondence.
Email: ncnmaximova@mail.ru
Russian Federation, Moscow
References
- Брюхов В.В., Максимова М.Ю., Коновалов Р.Н., Кротенкова М.В. Современные возможности визуализации гипертензивных супратенториальных внутримозговых кровоизлияний. Неврол. журн. 2007; 6: 36–42.
- Верещагин Н.В., Моргунов В.А., Гулевская Т.С. Патология головного мозга при атеросклерозе и артериальной гипертонии. М.: Медицина, 1997.
- Гулевская Т.С. Морфологические основы дисциркуляторной энцефалопатии при артериальной гипертонии. В кн.: Сб. статей и тезисов II Национального конгресса «Кардионеврология» (под ред. З.А. Суслиной, М.А. Пирадова, А.В. Фонякина). М., 4–5 декабря, 2012: 23–29.
- Гулевская Т.С., Людковская И.Г. Артериальная гипертония и патология белого вещества головного мозга. Арх. пат. 1992; 2: 53–59.
- Гулевская Т.С., Моргунов В.А. Патологическая анатомия нарушений мозгового кровообращения при атеросклерозе и артериальной гипертонии. Руководство для врачей. М.: Медицина, 2009.
- Зайратьянц О.В. Анализ смертности, летальности, числа аутопсий и качества клинической диагностики в Москве за последнее десятилетие (1991–2000 гг.). Арх. пат. Приложение. М.: Медицина, 2002.
- Кистенев Б.А., Максимова М.Ю., Брюхов В.В. Варианты нарушений мозгового кровообращения при артериальной гипертонии. Анн. клин. и эксперимент. неврол. 2007; 3: 49–55.
- Колтовер А.Н., Людковская И.Г., Гулевская Т.С. и др. Гипертоническая ангиоэнцефалопатия в патологоанатомическом аспекте. Журн. невропатол. и психиатр. 1984; 7: 1016–1020.
- Колтовер А.Н., Моргунов В.А., Людковская И.Г. и др. Гипертоническая ангиопатия головного мозга. Арх. пат. 1986; 11:34–39.
- Людковская И.Г., Гулевская Т.С., Моргунов В.А. Деструктивные изменения средней оболочки интрацеребральных артерий при артериальной гипертензии. Арх. пат. 1982; 9: 66–72.
- Моргунов В.А., Гулевская Т.С. Лакунарное состояние и кровоизлияние в головной мозг. Арх. пат. 1980; 9: 23–28.
- Пирадов М.А. Геморрагический инсульт: новые подходы к диагностике и лечению. Атмосфера. Нервные болезни. 2005; 1:17–19.
- Суслина З.А., Варакин Ю.Я., Верещагин Н.В. Сосудистые заболевания головного мозга. Эпидемиология. Основы профилактики. М.: МЕДпресс-информ, 2006.
- Ширшов А.В., Добжанский Н.В., Пирадов М.А., Верещагин Н.В. Современные подходы к хирургическому лечению спонтанных кровоизлияний в мозг. В кн.: Очерки ангионеврологии (под ред З.А. Суслиной). М.: Атмосфера, 2005: 222–230.
- Broderick J., Connolly S., Feldmann E. et al. Guidenlines for management of spontaneous intracerebral hemorrhage in adults. Update. Stroke. 2007; 38 (6): 2001–2023.
- Carey C., Kramer J., Josephson S. et al. Subcortical lacunes are associated with executive dysfunction in cognitively normal elderly. Stroke. 2008; 39 (2): 397–402.
- Das R., Seshadri S., Beiser A. et al. Prevalence and correlates of silent cerebral infarcts in the framingham offspring study. Stroke. 2008; 39 (11): 2929–2935.
- Doubal F., Maclullich A., Ferguson K. et al. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke. 2010; 41 (3): 450–454.
- Eguchi K., Kario K., Shimada K. Greater impact of coexistence of hypertension and diabetes on silent cerebral infarcts. Stroke. 2003; 34 (10): 2471–2474.
- Fisher M., Vasilevko V., Cribbs D. Mixed Cerebrovascular disease and the future of stroke prevention. Transl. Stroke Res. 2012; 3 (Suppl.1): S39–S51.
- Folsom A., Yatsuya H., Mosley T. et al. Risk of intraparenchymal hemorrhage with magnetic resonance imaging-defined leukoaraiosis and brain infarcts. Ann Neurol. 2012; 71 (4): 552–559.
- Gebel J., Broderick J. Intracerebral haemorrhage. J. of Clinical Neurology. 2000; 18: 419–438.
- Giele J., Witkamp T., Mali W., Van der Graaf Y. Silent brain infarcts in patients with manifest vascular disease. Stroke. 2004; 35 (3): 742–746.
- Gorelick P., Bowler J. Advances in Vascular Cognitive Impairment, Stroke, 2010; 41: e93-e98.
- Gorter J.W., Algra A., Van Gijn J. et al. Study group. SPIRIT: predictors of anticoagulant-related bleeding complications in patients after cerebral ischemia. Cerebrovasc. Dis. 1997; 7 (4): 3.
- Gouw A., Van der Flier W., Pantoni L. et al. On the etiology of incident brain lacunes. longitudinal observations from the LADIS study. Stroke. 2008; 39 (11): 3083–3085.
- Gregoire S., Brown M., Kallis C. et al. MRI Detection of new microbleeds in patients with ischemic stroke. Five-year cohort followup study. Stroke. 2010; 41 (1): 184–186.
- Grinberg L., Thal D. Vascular pathology in the aged human brain. Acta Neuropathol. 2010; 119: 277–290.
- Inzitari D., Diaz F., Fox A. et al. Vascular risk factors and leukoaraiosis. Arch. Neurol. 1987; 44: 42–47.
- Jackson C., Hutchison A., Dennis M. et al. Differing risk factor of ischemic stroke subtypes. Evidence for a distinct lacunar arteriopathy? Stroke. 2010; 41 (4): 624–629.
- Kang D., Han M., Kim H. et al. New ischemic lesions coexisting with acute intracerebral hemorrhage. Neurology 2012; 79 (9): 848–855.
- Knottnerus I., Govers-Riemslag J., Hamulyak K. et al. Endothelial activation in lacunar stroke subtypes. Stroke. 2010; 41 (8): 1617–1622.
- Kwon H., Kim B., Lee S. et al. Metabolic syndrom as an independent risk factor of silent brain infarction in healthy people. Stroke. 2006; 37 (2): 466–470.
- Lou M., Al-Hazzani A., Goddeau R. et al. Relationship between white-matter hyperintensities and hematoma volume and growth in patients with intracerebral hemorrhage. Stroke. 2010; 41 (1): 34–40.
- MacLullich A., Ferguson K., Reid L. et al. Higher systolic blood pressure is associated with increased water diffusivity in normal-appearing white matter. Stroke. 2009; 40 (12): 3869–3871.
- Menon R., Burgess R., Wing J. et al. Predictors of highly prevalent brain ischemia in intracerebral hemorrhage. Ann Neurol. 2012; 71 (2): 199–205.
- Pantoni L. Leukoaraiosis: From an ancient term to an actual marker of poor prognosis. Stroke. 2008; 39 (5): 1401–1403.
- Potter G., Doubal F., Jackson C. et al. Counting cavitating lacunes underestimates the burden of lacunar infarction. Stroke. 2010; 41 (2): 267–272.
- Schmidt R., Petrovic K., Ropele S. et al. Progression of leukoaraiosis and cognition. Stroke. 2007; 38 (9): 2619–2625.
- Smith E., Nandigam K., Chen Y. et al. MRI markers of small vessel disease in lobar and deep hemispheric intracerebral hemorrhage. Stroke. 2010; 41 (9): 1933–1938.
- Staals J., Oostenbrugge R., Knottnerus I. et al. Brain microbleeds relate to higher ambulatory blood pressure levels in first-ever lacunar stroke patiens. Stroke. 2009; 40 (10): 3264–3268.
- Thijs V., Lemmens R., Schoofs C. et al. Microbleeds and the risk of recurrent stroke. Stroke. 2010; 41 (9): 2005–2009.
- Van Dijk E., Prins N., Vrooman H. et al. Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences. Rotterdam scan study. Stroke. 2008; 39 (10): 2712–2719.
- Wardlaw J. What is a lacune? Stroke. 2008; 39 (11): 2921–2922.
- Wardlaw J., Sandercock P., Dennis M., Starr J. Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke. 2003; 34 (3): 806–812.
- Woo D., Haverbusch M., Sekar P. et al. Effect of untreated hypertension on hemorrhagic stroke. Stroke. 2004; 35 (7): 1703–1708.
- Wright C., Moon Y., Paik M. et al. Inflammatory biomarkers of vascular risk as correlates of leukoariosis. Stroke. 2009; 40 (11): 3466–3471.
- Yakushiji Y., Nishiyama M., Yakushiji S. et al. Brain microbleeds and global cognitive function in adults without neurological disorder. Stroke. 2008; 39 (12): 3323–3328.
- Yamada S., Saiki M., Satow T. et al. Periventricular and deep white matter leukoaraiosis have a closer association with cerebral microbleeds than age. European Journal of Neurology. 2012; 19: 98–104.
- Zhu Y., Dufouil C., Tzourio C., Chabriat H. Silent brain infarcts. A review of MRI diagnostic criteria. Stroke. 2011; 42 (4): 1140–1145.
- Zhu Y., Tzourio C., Soumare A. et al. Severity of dilated virchowrobin spaces is associated with age, blood pressure, and MRI markers of small vessel disease: a population-based study. Stroke. 2010; 41 (11): 2483–2490.
- Zia E., Hedblad B., Pessah-Rasmussen H. et al. Blood pressure in relation to the incidence of cerebral infarction and intracerebral hemorrhage. Hypertensive hemorrhage: debated nomenclature is still relevant. Stroke. 2007; 38 (10): 2681–2685