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We describe a fatal primary thalamic/brain stem hemorrhage occurring in the context of sudden emotional upset. At autopsy, the brain harbored several perforating artery fibrinoid lesions adjacent to and remote from the hematoma as well as old lacunar infarcts and healed destructive small-vessel lesions. We postulate that the emotional upset caused a sudden risk in blood pressure/cerebral blood flow, mediating small-vessel fibrinoid necrosis and rupture. This or related mechanism may underlie many small-vessel strokes. |
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