- “Stroke” can occur in a young person, in this case a 20 year old woman.
- She had an undiagnosed vascular disease and hypertension.
Post mortem pathology
This is a coronal slice from the parietal region of her brain.
- There is a large right sided haemorrhage in the region of the basal ganglia, specifically the putamen, which is the commonest site for hypertensive haemorrhage.
- The haemorrhage has ruptured into the ventricular system,
- and midline structures are displaced to the left.
- A year before her death the patient had a right-sided hemiparetic attack, which resolved completely.
- On the left side of the specimen in the region of the putamen there is a cystic lesion with brownish discolouration.
- This is the scar of a previous cerebral haemorrhage, which probably accounts for that episode.
- Hypertension causes abnormalities in vessel walls.
- In the brain, the small penetrating arterioles are affected.
- The changes include lipohyalinosis and fibrinoid necrosis, which weakens the arteriolar walls. Minute aneurysms (Charcot-Bouchard aneurysms) are often formed. The arterioles are vulnerable to rupture.
- In this case a rupture has occurred in one of the penetrating lenticulostriate branches of the middle cerebral artery.
- Other common sites for hypertensive bleeds are the thalamus, pons and cerebellar hemispheres.