Charcot–Bouchard Dilatations (Anevrysmes Miliaire) and the Search for the Cause of Cerebral Hemorrhage

NCJ_cover.jpgBy Eelco F. M. Wijdicks MD, PhD

First Online: 24 January 2020

Cerebral hemorrhage had been recognized since Johann Jakob Wepfer in 1658 reported it as a cause of apoplexy (Schlaganfall). At autopsy, he would find sanguineous fluid within cavities of the brain [1,2,3]. Hemorrhage due to abnormal arteries was investigated as early as the nineteenth century with John Cheyne (1777–1836), who believed it to be a result of a bleeding vascular malformation [4]. It became much more interesting when Jean-Martin Charcot (12 years his senior) asked his resident Charles Bouchard to study the pathogenesis of cerebral hemorrhage. This work resulted in Bouchard’s doctoral thesis. Bouchard attributed hemorrhage in older patients to ruptured miliary aneurysm. In a wordy and ambiguous explanation, he attributed the cause to “exaggerated blood pressure in the vessels of the brain,” which, in turn, was due to “preliminary vascular deterioration, always identical, and sclerosis in small arteries with atrophy of the tunica media and secondary production of aneurysms, the rupture of which is the direct cause of hemorrhage.” Saccular or fusiform dilatations, 250–400 µ in diameter, were found on small arteries in all parts of the brain, and microscopic degenerative changes were noted predominantly in the adventitia. It was suggested that these aneurysms occurred as a consequence of “periarteritis” and that the degenerative process leading to aneurysm formation was unrelated to atheroma [5,6,7,8]. These aneurysms had been previously described by a number of prior investigators (e.g., Gull, Cruveilhier, Calmeil, Meynert, Heschl), but they were never associated with cerebral hemorrhage.

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