Mizutani T, Kojima H, Miki Y
Department of Neurosurgery, Tokyo Metropolitan Fuchu Hospital, Japan.
J Neurosurg. 2000 Nov;93(5):859-62. doi: 10.3171/jns.2000.93.5.0859.
For the past 130 years, it has been believed that hypertension-induced cerebral hemorrhages are the result of ruptures of microaneurysms or ruptures of arteries that have degenerative changes. The majority of previous investigations have focused on autopsied brain. In this study, the authors attempted to verify the cause of hypertension-induced cerebral hemorrhage by using surgical specimens of the penetrating arteries responsible for the hemorrhages.
Between 1997 and 1999, the authors performed pathological studies in surgical specimens of lenticulostriate arteries that had been confirmed during microsurgery to be the cause of hypertension-induced hemorrhage of the putamen. Nineteen lenticulostriate arteries were collected from 12 patients. Fifteen of these arteries were verified as the pathological causes of hemorrhage. They included six arterial dissections, six arterial ruptures with substantial degenerative changes, and three arterial ruptures with few degenerative changes. The pathological findings in the lenticulostriate artery dissections were similar to those of typical arterial dissections in major cerebral arteries.
To the best of the authors' knowledge, arterial dissections of lenticulostriate arteries have not been identified as a cause of hypertension-induced cerebral hemorrhages. When penetrating arteries are included as causative vessels, cerebral arterial dissections may be much more common than previously thought.
在过去的130年里，人们一直认为高血压性脑出血是微动脉瘤破裂或发生退行性改变的动脉破裂所致。以往大多数研究都集中在尸检大脑上。在本研究中，作者试图通过使用导致出血的穿通动脉的手术标本，来验证高血压性脑出血的病因。
1997年至1999年期间，作者对在显微手术中已被证实为高血压性壳核出血病因的豆纹动脉手术标本进行了病理学研究。从12例患者中收集了19条豆纹动脉。其中15条动脉被证实为出血的病理原因。它们包括6例动脉夹层、6例伴有大量退行性改变的动脉破裂以及3例伴有少量退行性改变的动脉破裂。豆纹动脉夹层的病理表现与大脑主要动脉典型动脉夹层的表现相似。
据作者所知，豆纹动脉夹层尚未被确定为高血压性脑出血的病因。当将穿通动脉列为致病血管时，脑动脉夹层可能比以前认为的更为常见。
