• This is a lateral view of the brain with the frontal lobes
to the left and the occipital lobes and cerebellum to the
• The arrows point to numerous petechial hemorrhages which could be due to blood dyscrasias such as seen in terminal leukemias, ITP, etc. or due to toxins such as arsenic.
|Cerebral or cerebellar hemorrhage|
•The most common cause of intraparenchymal hemorrhage
•Other causes include blood dyscrasias
or rupture of vascular malformations.
•Hypertensive hemorrhages are often due to hypertensive
lipohyalinosis of of small arteries with formation of
small Charcot-Bouchard aneurysms.
cause bleeding due to inability of the blood to clot.
•Hemorrhages from vascular malformations are caused
by trauma or hypertension further damaging an abnormal
blood vessel wall.
•Eighty percent of intraparenchymal hemorrhages in the
hypertensive are found in the basal ganglia, thalamus
or white matter.
• Ten percent are seen in the pons,
and 10% in the cerebellar hemispheres.
•They may also rupture into the ventricle which may
cause death or may be helpful in decompression.
•Blood dyscrasias such as leukemias often produce many
small petechial or larger hemorrhages.
malformations may rupture due to hypertension, trauma
or abnormalities of the blood vessel wall.
•Symptoms associated with hemorrhages depend on the extent of the bleed.
•Symptoms can range from a silent lesion to a devastating disability to coma and a lethal outcome.
|General Gross Description|
•Intraparenchymal and intraventricular hemorrhages appear
as a mass of blood in the brain tissue or ventricle.
•The walls of a large
hemorrhage thought to be due to hypertension should be examined for abnormal vessels.
|General Micro Description|
•Microscopically hemorrhages are surrounded by pallor
of tissue, spongiosus, and pericellular vacuolization.
is a collagenous capsule around an old hemorrhage with
hemosiderin laden macrophages still present.
• Poirer J et.al. Manual of basic neuropathology. Philadelphia: Saunders, 1990, pp.65-78,
• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp.1311-1312.