抄録
On the emergency surgery against hypertensive intracerebral hemorrhages of 18 patients, arteriolar biopsies were performed from each lenticulostriate arteries with ruptured hemorrhages. They were, then, serially sectioned and were examined by electron-microscopy as well as light microscopy.
The examination revealed six disrupted ostiums of the arterial walls causing massive hemorrhages, in 18 individuals. Four of them were ruptured at bifurcations of the arteries with arteriosclerotic changes which were characterized by smooth muscle cell degeneration in media as well as in intima, if thickened, and termed “exhausted degeneration” in this paper. That is, irregular or moth eaten-like atrophy of the smooth muscle cell with remarkable increase of its basement membranoid materials. The internal elastic lamella was sharply disrupted without any previous alterations at disrupted ostium. Ultrastructurally, there is, however, neither fibrinoid nor insudative changes at the disrupted portion, as a previous alteration. The disruption was not respected to lipid deposition in intima and/or media.
Microneurysm (“angionecrosis”) was another cause of the rupture in two remained patients. The wall of the microaneurysm, however, ultrastracturally comprised quit various components; only lamellar fibrin sheats or with intermingled inflammatory cells and/or lipophage, or with partially or completely regenerated endothelium and imigration of immatured smooth muscle cell (or indeterminated cell), intercellular deposition of calcium as well as ferrum as an electron dense granule, which were detected by electron microscopic x-ray analyzer. Those are quit different from that in hypertensive fibrinoid thickening of arterioles in other organs. Thus, the microaneurysm which thought causally relate to primary intracerebral hemorrhage, is rather easily understandable to be a resorbed state of a smaller or incomplete, subclinical hemorrhage.
On conclusions, hypertensive intracerebral hemorrhages occure more frequent from primary rupture of arteriosclerotic lesions than from microaneurysm which is more likely to be old recanalized, small hemorrhage.
