PMC6413389_01
(a) Axial T2-weighted gradient echo magnetic resonance image showing hemorrhage in the left basal ganglia. (b) Gross photograph of coronal sections through the cerebral hemispheres. Scale bar = 1 cm. L = left; R = right.
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MRI scan gradient echo mapping highlighted the extent of the hematoma in the left basal ganglia (Figure 1(a)). MRA (magnetic resonance angiography) of the circle of Willis demonstrated normal intracranial vessels without focal stenosis or aneurysmal dilatation. There was a discrete hematoma in the left superior frontal gyrus and hemorrhage in the right median frontal cortex and in white matter adjacent to the right orbitofrontal surface (Figure 1(b)).
(a) Hemorrhage within the left frontal cortex. (b) Inflamed vessel in the left frontal cortex. (c) Vessel showing intraluminal thrombus and fibrinoid necrosis in white matter adjacent to the left putamen. (d) Immunohistochemistry of vessel in the left putamen, negative for CD3 and CD68 but positive for LCA. Scale bars: (a) 0.5 cm; (b-d) 100 microm.
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Hematoxylin and eosin/luxol fast blue stained sections showed extensive acute hemorrhage with infarction (Figure 2(a)). Vessels showed invasion by leucocytes (Figure 2(b)) as well as fibrinoid necrosis of the wall (Figure 2(c)). Invading leucocytes were rarely positive for the lymphocyte marker CD3 or the macrophage-microglia marker CD68 but more often positive for the general white blood cell marker Leucocyte Common Antigen (LCA/CD45) consistent with neutrophils (Figure 2(d)). Some vessels contained luminal thrombus (Figure 2(c)).
Scatter plot showing ratio of wall thickness to diameter as a function of vessel diameter in 173 pathologically affected blood vessels.
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The ratio of wall thickness to diameter is plotted as a function of vessel diameter in Figure 3.