Hypertensive Cerebrovascular Disease

Question 1

The most important effects of hypertension on the brain include ____________________

The incidence of these disorders is likely to decline with increased screening for
hypertension and aggressive management of blood pressure

Answer 1

• lacunar infarcts,
• slit hemorrhages,
• and hypertensive encephalopathy,
• as well as massive hypertensive intracerebral hemorrhage.

Question 2

Hypertension affects the deep penetrating arteries and arterioles that supply the basal ganglia
and hemispheric white matter as well as the brainstem.

These cerebral vessels develop
arteriolar sclerosis and may become occluded; the structural changes are similar to those
described in the systemic vessels of individuals with hypertension ( Chapter 11 ).

An important
clinical and pathologic consequence of CNS arterial lesions is the development of single or
multiple, small, cavitary infarcts known as______________( Fig. 28-17 ).

Answer 2

lacunae

Question 3

Answer 3

lacunar infarcts

Question 4

What are lacunar infarcts?

Answer 4

These are:

• lake-like spaces,
• less than 15 mm wide, which occur in the **lenticular nucleus, thalamus, internal capsule, deep white matter, caudate nucleus, and pons, in descending order of frequency. **

Question 5

Where does lacunar infarct mostly found in descending order? of frequency?

Answer 5

• lenticular nucleus,
• thalamus,
• internal capsule,
• deepwhite matter,
• caudate nucleus,
• and pons,

Question 6

What is the appearance of lacunar infarcts in microscopic exam?

Answer 6

On microscopic
examination they consist of areas of tissue loss with:

• scattered lipid-laden macrophages and
• surrounding gliosis.
• Depending on their location in the CNS, lacunae can either be clinically silent or cause severe neurologic impairment. Affected vesselsmay also be associated with widening of the perivascular spaces but without tissue infarction (état criblé).

Question 7

What is slit hemorrhage?

Answer 7

Slit Hemorrhages
Hypertension also gives rise to rupture of the small-caliber penetrating vessels and the
development of small hemorrhages.

In time these hemorrhages resorb, leaving behind a slitlike
cavity (slit hemorrhage)surrounded bybrownish discoloration; on microscopic examination, slit
hemorrhages show focal tissue destruction, pigment-laden macrophages, and gliosis.

Question 8

microscopically, what is the appearance of slit hemorrhage?

Answer 8

on microscopic examination, slit
hemorrhages show focal tissue destruction, pigment-laden macrophages, and gliosis.

Question 9

Acute hypertensive encephalopathy is a clinicopathologic syndrome arising in an individual with
malignant hypertension, and is characterized by___________________

Rapid
therapeutic intervention to reduce the accompanying increased intracranial pressureis
required, since the syndrome often does not remit spontaneously.

At postmortem examination
such individuals may show an edematous brain with or without transtentorial or tonsillar
herniation.

Answer 9

• diffuse cerebral dysfunction,
• including headaches
• , confusion,
• vomiting, and convulsions,
• sometimes leading to coma.

Question 10

What can be seen in hypertensive encephalopathy

Answer 10

Petechiae and fibrinoid necrosis of arterioles in the gray and white matter may be
seen microscopically.

Question 11

Hypertensive Encephalopathy

Individuals who, over the course of many months and years, suffer multiple, bilateral, gray
matter (cortex, thalamus, basal ganglia) and white matter (centrum semiovale) infarcts may
develop a distinctive clinical syndrome characterized by dementia, gait abnormalities, and
pseudobulbar signs, often with superimposed focal neurologic deficits.

The syndrome, generally
referred to as vascular (multi-infarct) dementia, is caused by multifocal vascular disease of
several types, including_________, ___________ and ___________. When the pattern of injury preferentially involves large areas of the subcortical
white matter with myelin and axon loss, the disorder is referred to as Binswanger disease; this
distribution of vascular white-matter injury must be distinguished clinically and radiologically

Answer 11

(1) cerebral atherosclerosis,
(2) vessel thrombosis or embolization from **carotid vessels or from the heart, and
(3) cerebral arteriolar sclerosis from chronic **hypertension

Question 12

Hypertensive Encephalopathy

When the pattern of injury preferentially involves large areas of the subcortical
white matter with myelin and axon loss, the disorder is referred to as ___________ this
distribution of vascular white-matter injury must be distinguished clinically and radiologically from other diseases that affect the hemispheral white matter

Answer 12

Binswanger disease;