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Charcot-Bouchard aneurysms revisited: clinicopathologic correlations

Shino Magaki1, Zesheng Chen2, Mohammad Haeri2,3

  • 1Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, CA, USA. smagaki@mednet.ucla.edu.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
|July 30, 2021
PubMed

Insights

Charcot-Bouchard aneurysms (CBAs) are rare in elderly individuals and may not be a primary cause of intracerebral hemorrhage (ICH). These findings suggest CBAs represent severe cerebral small vessel disease, linked to hypertension and cerebral amyloid angiopathy (CAA).

Area of Science:

  • Neurology
  • Pathology
  • Vascular Biology

Background:

  • Intracerebral hemorrhage (ICH) is a major cause of death and disability globally.
  • Hypertension and cerebral amyloid angiopathy (CAA) are primary ICH causes, but hemorrhage mechanisms remain unclear.
  • Charcot-Bouchard aneurysms (CBAs) are debated as a cause of ICH, though associated with hypertensive arteriopathy and CAA.

Purpose of the Study:

  • To investigate the clinicopathologic findings and significance of Charcot-Bouchard aneurysms (CBAs) in relation to intracerebral hemorrhage (ICH).
  • To determine the prevalence and associated comorbidities of CBAs in autopsy cases.

Main Methods:

  • Retrospective analysis of over 2700 routine autopsies at a tertiary academic medical center.
  • Detailed clinicopathologic examination of identified Charcot-Bouchard aneurysms (CBAs).

Main Results:

  • Charcot-Bouchard aneurysms (CBAs) were identified in 12 cases (0.44%), predominantly in elderly individuals with multiple comorbidities.
  • Only one subject with CBAs had a large ICH; hemorrhage etiology was likely multifactorial.
  • CBAs were associated with microhemorrhages and infarcts, indicating severe cerebral small vessel disease.

Conclusions:

  • Charcot-Bouchard aneurysms (CBAs) are rare and may not be a significant direct cause of large intracerebral hemorrhage (ICH).
  • CBAs are a manifestation of severe cerebral small vessel disease, encompassing hypertensive arteriopathy and cerebral amyloid angiopathy (CAA).
  • Further research is needed to fully elucidate the role of CBAs in cerebrovascular pathology.

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