The pathogenesis of secondary midbrain hemorrhages

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Abstract
Complete serial sections of pons, midbrain, and attached diencephalon in 6 cases with secondary midbrain hemorrhages showed that the number of hemorrhages is greater than the number evident from routine specimens. Nearly all the secondary hemorrhages present were due to focal necrosis and disintegration of medium-sized arteries, with occasional retraction of the stumps. Arterial necrosis may occur near a bifurcation or in a straight portion of the vessel. The involved arteries could be traced without significant signs of preexisting vascular disease above and below the point of hemorrhage. Stretching of arteries due to anteroposterior elongation of the midbrain is suggested as the probable mechanism of arterial necrosis.