Predictors of massive intracerebral hemorrhages in arterial hypertension

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.