A 72-year-old man has had poorly controlled hypertension for the past 20 years. Over the past day he has had a severe headache with nausea, followed by confusion, then convulsions. On examination he is afebrile, but his blood pressure is now 260/150 mm Hg. There is bilateral papilledema. Which of the following pathologic lesions is most likely to have developed in his brain during the past day?
He developed acute hypertensive encephalopathy from the rapid and marked increase in blood pressure. There is extensive cerebral edema with increased intracranial pressure, but no localizing signs. The arterioles are involved, and like malignant hypertension involving the kidney, there is fibrinoid necrosis and petechial hemorrhages. Telangiectasias may be one form of vascular malformation, typically a localized lesion not related to hypertension. Lacunar infarcts develop with hypertension, but they tend to be small and are often silent, but may cause significant neurologic impairment, though more likely a focal deficit due to focal involvement. Hypertensive hemorrhages may be large, and the basal ganglia region is a common location, but such a lesion could produce a unilateral mass effect with papilledema on one side. Subarachnoid hemorrhages are more likely to occur from ruptured saccular aneurysms.
Arteriolar fibrinoid necrosis
Cortical telangiectasia
Lacunar infarction
Putaminal hematoma
Central Nervous System