Hypertensive Cerebellar Hemorrhage

[MrHGB]

Is it possible to have a hypertensive hemorrhage in the brain when the body's blood pressure is normal? My wife recently died from a cerebellar hemorrhage. She had hypertension, but took her medication regularly. Her blood pressure both before and after the event was recorded as normal. The official diagnosis after a cranial autopsy, however, was hypertensive cerebellar hemorrhage.

[MG (Admin)]

Sorry to hear about your wife.

How old was she and how long had she been treated with medications?
When was she diagnosed as having high BP?
Which medications was she on (including those unrelated to BP)?
Did she have any other conditions?
Do you remember how high her BP was (before or after treatment).

[MrHGB]

She was 36 and had been taking Methyldopa for hypertension for about 7 years. Her blood pressure was reported normal (about 130/80 I believe) a few minutes before her collapse. She had just come out of an appointment with her neurologist (ironically). The notes from that visit reported normal blood pressure and I don't think they had any reason to alter the record. The neurologist had been treating her for a little over a year for Pseudotumor Cerebri and I think it was the leading complication in masking whatever else was wrong with her. I believe the symptoms of that condition, headaches specifically, kept anyone from digging further. Every time she had a headache, even severe debilitating ones, it was blamed on the PC. To make it worse, she kept messing with her dosages and switching between Diamox and Topamax, trying to find a balance between headaches and side effects.

She had had a few really bad headaches through that year, were she could hardly move or talk, just like the one before she collapsed. In hindsight, they seem like warning signs that we may have missed. That day, she had just come out of the appointment and gotten into the car when it hit. She was able to call me (that's how I know it was the same kind of headache) and call 911. Twelve minutes later she was unconscious and never woke up. The only diagnosis I ever got from anyone, was that she had a massive bleed in her cerebellum. No one knew why or how. An independent autopsy diagnosed the hemorrhage as "hypertensive".

That never made much sense to me, hence my posting. It seems like your BP would have to be really high to cause a vessel to rupture in your brain. She had taken her medication for years and always had normal readings.

I wondered, also, if there could have been some combination of drugs that could weaken cranial vessels. She was a critical care nurse and read the drug interaction warnings religiously. Unfortunately, that also meant she was a terrible patient, as many medical professionals are, and she was a little drug happy, for lack of a better phrase. She took many regular medications.
Topamax - Pseudotumor Cerebri
Diamox - PC
Methyldopa - hypertension
Lortab - various back aches and pains
Zoloft - general depression
Zyrtec - allergies
Albuterol inhaler - asthma
Flexeril - various muscle aches
Ambien - insomnia

[MG (Admin)]

Well it is important to understand that the effects of BP on blood vessels can are long-term ones and it is usually not the high BP at any one moment that is the cause of the long-term blood vessel damage.

These long-term changes can eventually cause a bleed even if the BP is well controlled...we all have changes in BP throughout the day and it is likely that her BP was a bit high when the bleed happened, high enough to cause a bleed from her damaged blood vessels although probably not high enough to cause a problem in someone without a longterm problem.

Of course this is just a theory...but reasonably likely in my opinion.

By the way..when was the last time she had her eyes checked or had a lumbar puncture before the bleed happened?

[MrHGB]

It was one year and three months previous to the hemorrage when she went to see the neurologist about headaches and visual disturbances. She got a lumbar puncture (revealing a high pressure), a full eye exam, and a full MRI. As far as I know, the eye exam didn't reveal anything serious and the MRI was normal. She had the classic symptoms of Pseudotumor Cerebri. I think it was correctly diagnosed.

Long term damage does make some sense. The summation of those health problems and normal life made for a lot of stress. Also, she kept adjusting her Diamox dosage and switching back and forth to Topamax, possibly allowing the condition to do more damage. I bet many of those intense headaches were minor bleeds that were able to repair themselves. I assume that weak vessels wouldn't show up on an MRI. Even if they did, I don't know what you could do about them.

Thanks for your help.

[MG (Admin)]

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