Stress-related primary intracerebral hemorrhage: autopsy clues to underlying mechanism.
BACKGROUND
Research into the causes of small-vessel stroke has been hindered by technical constraints. Cases of intracerebral hemorrhage occurring in unusual clinical contexts suggest a causal role for sudden increases in blood pressure and/or cerebral blood flow.


METHODS
We describe a fatal primary thalamic/brain stem hemorrhage occurring in the context of sudden emotional upset. At autopsy, the brain harbored several perforating artery fibrinoid lesions adjacent to and remote from the hematoma as well as old lacunar infarcts and healed destructive small-vessel lesions.


CONCLUSIONS
We postulate that the emotional upset caused a sudden rise in blood pressure/cerebral blood flow, mediating small-vessel fibrinoid necrosis and rupture. This or a related mechanism may underlie many small-vessel strokes.
Lammie
G A
GA
Department of Pathology, University of Edinburgh, Scotland. al@skull.dcn.ed.ac.uk
Lindley
R
R
Keir
S
S
Wiggam
M I
MI
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology; D004644:Emotions; D017809:Fatal Outcome; D005355:Fibrosis; D006406:Hematoma / Q000209:etiology / Q000473:pathology; D018056:Hemorheology; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008636:Mesencephalon / Q000098:blood supply; D009336:Necrosis; D012422:Rupture, Spontaneous; D013315:Stress, Psychological / Q000150:complications* / Q000473:pathology; D013788:Thalamus / Q000098:blood supply