Fig. 2

Histopathological findings in a fatal case of PRES due to hypertension. A The frontal basal white matter appears normal. The black asterisk at the top right is to identify cerebral cortex with fresh hypoxemic-ischemic nerve cell damage in the form of cytoplasmic shrinkage, hypereosinophilia and nuclear condensation. B In contrast to frontal basal (A), the slices obtained from occipital white matter are characterized by diffuse myelin pallor and mildly increased glial cell density. C-D Slices obtained from cerebellar white matter with myelin pallor and mild reactive glial cell proliferation. In panel C, one sees two thin-walled blood vessels with hyperemia and a perivascular exsudate indicative of endothelial cell damage (black arrows). Panel D shows three thin-walled hyperemic blood vessels (black arrows). The central blood vessel is surrounded by some macrophages with vacuolated cytoplasms (“phagocytes”) indicative of myelin sheath break down products. In the small slice embedded in panel D, two thin-walled blood vessels (black arrows) with fibrinoid vascular wall necrosis can be seen at the top right and a petechial microbleeding area (black asterisk) at the bottom left. Hematoxylin and eosin staining of all slices; Scale bar = 100 μm/50 µm