Abstract：
A 55-year-old Japanese woman with a history of hypertension and right putaminal hemorrhage developed simultaneous hemorrhages in the left thalamus and putamen and died 24 h later. There were no vascular anomalies in the brain. Synaptophysin immunostaining combined with eosin azure 50 (EA50) staining clearly identified the hematoma and the surrounding brain structures. In the right cerebral hemisphere, a cystic lesion as a sequela of the usual type of hypertensive putaminal hematoma was evident. In the left cerebral hemisphere, two fresh hematomas were evident. One was a thalamic hematoma, which had destroyed the dorsal and medial structures of the thalamus, and the other was an unusual putaminal hematoma, which had destroyed the entire putamen and crossed the internal capsule and caudate nucleus. α-Smooth muscle actin immunostaining combined with EA50 and Victoria bleu staining demonstrated three ruptured arteries associated with fibrin aggregates in the anterior thalamic nucleus and anterior putamen. Some circular structures composed of fibrin, suggesting the presence of ruptured arteries in the neighborhood, were evident in the thalamus and putamen. In the putamen, ruptured arteries and circular structures were present in the lateral to medial areas. Fibrin aggregates in the anterior thalamic nucleus were more numerous than those in the putamen. On the basis of these findings, we concluded that: (i) the artery with numerous fibrin aggregates in the anterior thalamic nucleus had ruptured first, followed by the arteries distributed in other parts of the thalamus and putamen; (ii) the unusual putaminal hematoma was attributable to rupture of the arteries around the center of the putamen, which are not responsible for the usual type of hypertensive putaminal hematoma; and (iii) it is suggested that even if hypertensive hemorrhage occurs simultaneously in the ipsilateral putamen and thalamus, the usual type of hypertensive mixed-type hematoma does not form.
摘要：
一名55岁的日本妇女，有高血压和右壳出血史，在左丘脑和壳核同时发生出血，并在24小时后死亡。大脑中没有血管异常。突触素免疫染色结合伊红天青50（EA50）染色清楚地识别了血肿和周围的大脑结构。在右脑半球，囊性病变是常见类型的高血压性肠外血肿的后遗症。在左脑半球，两个新鲜的血肿是明显的。一个是丘脑血肿,破坏了丘脑的背侧和内侧结构，另一个是不寻常的破乳血肿，它破坏了整个壳核，穿过了内囊和尾状核。α-平滑肌肌动蛋白免疫染色结合EA50和Victoriableu染色显示出三个破裂的动脉，这些动脉与前丘脑核和前壳核的纤维蛋白聚集体有关。一些由纤维蛋白组成的圆形结构，这表明附近有动脉破裂,在丘脑和壳核都很明显。在壳核中，外侧至内侧区域存在破裂的动脉和圆形结构。丘脑前核的纤维蛋白聚集体比壳核中的纤维蛋白聚集体更多。根据这些发现,我们得出的结论是：（i）丘脑前核有大量纤维蛋白聚集体的动脉首先破裂，其次是分布在丘脑和壳核其他部位的动脉；（ii）异常的壳核血肿归因于壳核中心周围的动脉破裂，这是不负责的通常类型的高血压性脑壳血肿;和（iii）建议，即使高血压出血同时发生在同侧壳核和丘脑，通常类型的高血压混合型血肿不会形成。
