Spontaneous basal ganglia hemorrhage
Usually as a result of poorly controlled long-standing hypertension.
It is probably not a factor in at least 35 % of basal ganglion hemorrhages.
The stigmata of chronic hypertensive encephalopathy are often present.
Most of the cases are spontaneous unilateral hemorrhage, and the volume of blood is usually < 30 cc 1).
Pathology
Long-standing poorly controlled hypertension leads to a variety of pathological changes in the vessels.
microaneurysms of perforating arteries (Microaneurysms of Charcot-Bouchard)
small (0.3-0.9 mm) diameter aneurysms that occur on small (0.1-0.3 mm) diameter arteries a distribution that matches incidence of hypertensive haemorrhages
80% lenticulostriate
10% pons
10% cerebellum
found in hypertensive patients may thrombose, leak (see cerebral microhaemorrhages) or rupture
accelerated atherosclerosis: affects larger vessels
hyaline arteriosclerosis
hyperplastic arteriosclerosis: seen in very elevated and protracted cases