Pathology cases – Hypertensive changes in small penetrating cerebellar arteries

Here is a comparison in how small penetrating arteries in the cerebellum differ between normotensive and hypertensive decedents.  First here is a medium power view normal vessel in a middle-aged woman:

A little closer up:

Now, here’s a medium power view of a cerebellar small artery in a hypertensive 50 year old woman:

A higher power view:

Note how the wall is thicker and more prominent.   It’s a bit subtle but it’s there.  Here’s a side-by-side:

In addition, if you look closely at the perivascular space in the hypertensive decedent, you’ll often see hemosiderin and/or hemosiderin-laden macrophages:

Here it is annotated:

It’s a bit subtle, but it can be important when building a case for death due to essential hypertension.  In addition to the more obvious changes in the heart, you can see hypertensive injury to vessels everywhere.  Along with the brain, the kidney is of course a good place to look.  Most people concentrate on subcapsular arteriolonephrosclerotic injury in the kidney, but you can also see subtle (and sometimes not so subtle) changes in the radial and arcuate arteries as well.  Adrenal cortical hyperplasia is also a decent indicator.  If you have a huge heart and big myocytes, it’s gilding the lilly, but sometimes you have a 480 gram heart with just small patchy myocyte hypertrophy.  In those cases, these subtle changes can help.

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