Ultrastructural morphometry of hypertensive medial damage in lenticulostriate and other arteries.

Abstract

SUMMARY Characteristic medial damage occurs in the distal lenticulostriate arteries in patients with hypertensive cerebral hemorrhage. Medial changes were studied in the proximal and distal lenticulostriate arteries and cortical circumflex arterioles. Additionally, intramyocardial coronary, gastric submucosal and renal interlobular arterioles were examined in hypertensive patients. Hypertensive medial damage consisted of irregular atrophy and paucity of smooth muscle with accumulation of nonfatty debris and basement membranes. These changes were diffuse, extensive and not uniform, and were unrelated to atherosclerosis or bifurcation. By electron microscopic morphometry smooth muscle occupied 28% of the media in the distal lenticulostriate arteries of hypertensive patients as compared with 80% in controls. The proximal lenticulostriate and cortical branches in hypertensive patients showed values higher than 50%, as did the coronary, gastric and renal arterioles. Massive primary hemorrhages are prevalent in the area supplied by the distal lenticulostriate artery, 150-660 / Mm in diameter. Fibrinoid necrosis and microaneurysm occur in more peripheral arterioles, 70-200 /xm. Thus, hypertensive medial damage with significant reduction of the smooth muscle area to less than 50% of the total media is viewed as an additional important factor which predisposes to sudden arterial rupture and massive cerebral hemorrhage.

Cerebral Microbleeds and Dilative Remodeling of the Basilar Artery: A Magnetic Resonance Imaging Study

“…Both IADE and SVDs affect the arterial media, and the involvement of matrix metalloproteinase metabolism has been postulated to bridge both conditions. 21 Characteristic medial damage occurs in the distal lenticulostriate arteries in patients with hypertensive cerebral hemorrhage 36 and has been associated with CMBs, 11 but we did not investigate the association between symptomatic cerebral hemorrhage and BA dilatation. After changes in the cerebral arteries, medial degeneration is the next most common pathological change in intrapericardial aortal dilatation.…”

Deep White Matter Hyperintensities, Decreased Serum Low-Density Lipoprotein, and Dilative Large Arteriopathy

“…Characteristic medial damage occurs in the distal lenticulostriate arteries in hypertensive cerebral hemorrhage 15 and cerebral aneurysm. 16 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which involves severe DWMHs, includes pathological alterations in the median and internal elastic lamella.…”

Aspects of intracerebral hematomas - an update

“…Patients with underlying hypertension have a vasculopathy that leads to weakness in the arteriole wall resulting in segments where the vessel is dilated and the wall is thinner than usual (46). This appears to occur particularly in the small lenticulostriate vessels which is the most frequent location for hypertensive hematomas (47). Further pathophysiology in ICH is in general independent of the etiology.…”