[Small vessel pathology and cerebral hemorrhage]

Spontaneous intracerebral hemorrhage may be due to two main arteriolopathies: HTA and age-related small vessel disease and cerebral amyloid angiopathy. Historical study of the CHARCOT-BOUCHARD microaneurysm controversy leads to conclude that altered arterioles may be ruptured with or, probably more often, without microaneurysms. Recent neuroradiological studies with gradient-echo T2*W MR imaging have confirmed a classical neuropathological fact: there is a strong correlation between subcortical ischemic lesions (lacune, leukoaraiosis) and subcortical hemorrhage (hematomas, microbleeds). Sporadic Cerebral Amyloid Angiopathy is the first cause of spontaneous intracerebral hemorrhage after 70 years. Hemorrhages are lobar, typically recurrent and/or associated with cortical microbleeds at T2*W imaging.