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(Stroke. 2000;31:1426.)
© 2000 American Heart Association, Inc.

Case Reports

Stress-Related Primary Intracerebral Hemorrhage

Autopsy Clues to Underlying Mechanism

G. Alistair Lammie, MD, PhD; Richard Lindley, MD, FRCP; Sarah Keir, MD, MRCP M. Ivan Wiggam, MD, MRCP

From the Department of Pathology (G.A.L.), University of Edinburgh, and Acute Stroke Unit, Western General Hospital (R.L., S.K., M.I.W.), Edinburgh, Scotland.

Abstract

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.

Case Description—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.

Key Words: hypertension • intracerebral hemorrhage • lacunar infarction • small-vessel disease

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