Which is the most common site of spontaneous intracerebral hemorrhage in a patient with chronic hypertension?
- A Putamen and adjacent internal capsule ✓
- B Cerebellar hemisphere
- C Pons
- D Lobar white matter
Correct answer: A. Putamen and adjacent internal capsule
Explanation
Chronic hypertension causes lipohyalinosis of deep penetrating arteries, producing Charcot-Bouchard microaneurysms. The lenticulostriate branches supplying the putamen are affected most often, making the putamen and internal capsule the commonest site, followed by thalamus, pons, and cerebellum. Lobar hemorrhage points instead toward cerebral amyloid angiopathy in the elderly, which kills that tempting distractor.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.