It is thought that the morphogenesis of plasmatic arterionecrosis as the direct cause of hypertensive intracerebral hemorrhage is initiated by medial smooth muscle necrosis, and hypertension is believed to be the cause of medial smooth muscle cell necrosis.Hypertension in rats with bilaterally constricted renal arteries can be normalized by removing the constricting clips from the renal arteries. Using this method, healing process of hypertensive medial smooth muscle cell necrosis in proximal and distal segments, especially in the former of the middle cerebral arteries was studied by light and electron microscopy.After the removal of clips in hypertensive rats with severe systolic hypertension over 200 mm Hg, blood pressure dropped remarkably. In these rats, mortality and incidence of brain lesions such as softening, edema and bleeding decreased compared with the same aged hypertensive rats.Electron microscopy showed that in the media of the proximal middle cerebral arteries, occurrence and progression of smooth muscle cell necrosis were suppressed and cell debris which had increased in the media of hypertensive rats diminished after the removal of clips. Basement membrane-like substances and collagen fibers were slightly increased in the medial extracellular space which decreased in width. The ratio of the total area of the media occupied by smooth muscle cells to the whole medial area became larger after the removal of clips as compared with that of hypertensive rats not only just before the removal of clips but also in the same experimental period.On the other hand, autoradiographic study revealed that no 3H-thymidine was incorporated into the nuclei of medial smooth muscle cells at any time till 21 days after the removal of clips.These facts indicate that total smooth muscle cell dimension in the media increased due to hypertrophy of the medial smooth muscle cells after the removal of clips.Thickness of the media of the proximal segments of the middle cerebral arteries was measured by Suwa's method. There was on difference in the thickness of the media of the animals with the constricted renal arteries between before and 4 weeks after the removal of clips from the arteries. But the thickness of the media in these animals was thicker than that of normotensive rats.Reaction products of intravenously injected horseradish peroxidase were seen in the vesicles of endothelial cells, but massive insudation of them by junctional transport into the subendothelial space was not observed before and after the removal of the clips. lt was the same in the untreated normotensive rats. So it can be said that increased vascular permeability did not play any role both in the occurrence and healing of the smooth muscle cell necrosis in this experimental study.In conclusion, necrosis of the medial smooth muscle cells in th cerebral arteries, considered to be a trigger for the development of plasmatic arterionecrosis in hypertensive patients may be healed with hypertrophy of the remained medial muscle cells after normalization of high blood pressure.