Gulevskaya T S, Anufriev P L, Evdokimenko A N
Research Center of Neurology, Moscow, Russia.
Arkh Patol. 2021;83(6):45-53. doi: 10.17116/patol20218306145.
Hypertension is the main cause and the most important risk factor for both acute cerebrovascular accident and chronic progressive cerebrovascular insufficiency that is accompanied by severe neurological and mental disorders even to the extent of developing dementia. They are based on hypertension-induced pathology of the intracerebral arteries and cerebral microvasculature - cerebral microangiopathy that leads to small deep (lacunar) infarcts (SDIs) and diffuse cerebral white matter diseases. This review highlights the morphology, pathogenesis, clinical and neuroimaging diagnosis of hypertensive SDIs, and their differential diagnosis with atherosclerotic SDIs in the historical aspect. It is emphasized that the lacunar state of the brain in hypertension is a predictor of massive cerebral hemorrhages. Special attention is paid to current studies of the morphology and pathogenesis of diffuse changes in white matter and to the role of blood-brain barrier impermeability in the development of progressive leukoencephalopathy.
高血压是急性脑血管意外和慢性进行性脑血管功能不全的主要病因及最重要的危险因素，后者可伴有严重的神经和精神障碍，甚至发展为痴呆。它们基于高血压引起的脑内动脉和脑微血管病变——脑微血管病，进而导致深部小（腔隙性）梗死（SDIs）和弥漫性脑白质疾病。本综述着重介绍高血压性SDIs的形态学、发病机制、临床及神经影像学诊断，以及从历史角度对其与动脉粥样硬化性SDIs的鉴别诊断。强调高血压时脑的腔隙状态是大量脑出血的一个预测指标。特别关注目前关于白质弥漫性改变的形态学和发病机制的研究，以及血脑屏障通透性在进行性白质脑病发展中的作用。
