Long-standing poorly-controlled hypertension leads to a variety of pathological changes in the vessels:
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Microaneurysms of perforating arteries (Charcot-Bouchard aneurysms)
- small (0.3-0.9 mm) diameter
- occur on small (0.1-0.3 mm) diameter arteries
- distribution matches the incidence of hypertensive hemorrhages
- 80% lenticulostriate
- 10% pons
- 10% cerebellum
- found in patients with hypertension
- may thrombose, leak (see cerebral microhemorrhages) or rupture
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Accelerated atherosclerosis: affects larger vessels
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Hyaline arteriolosclerosis
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hyperplastic arteriolosclerosis: seen in very elevated and protracted cases