A 70-year-old hypertensive man collapses and is brought to the emergency department unconscious. Non-contrast CT head performed within one hour shows a hyperdense lesion in the right basal ganglia with surrounding low-density edema and midline shift. What is the most likely diagnosis?

• A Hypertensive intracerebral hemorrhage ✓
• B Ischemic infarct in the right middle cerebral artery territory
• C Epidural hematoma
• D Cerebral abscess

Explanation

Hypertensive intracerebral hemorrhage most commonly occurs in the basal ganglia (putamen) due to rupture of lenticulostriate arteries, which are chronically damaged by sustained hypertension. On non-contrast CT, acute blood is hyperdense (60-80 HU) relative to brain parenchyma due to clot retraction and hemoglobin concentration. Ischemic infarcts appear as low-density (hypodense) areas. Epidural hematomas are biconvex and peripheral, not deep. Abscess would be ring-enhancing on contrast CT with a thick irregular wall.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.