Autopsy of a hypertensive patient reveals a massive intracer

[meenaxi]

Autopsy of a hypertensive patient reveals a massive intracerebral hemorrhage filling the ventricles. A thorough search for the source of the hemorrhage is likely to demonstrate that the bleeding began in which of the following sites?

A. Basal ganglia and internal capsule

B. Central white matter

C. Cerebellum and medulla

D. Pons

E. Thalamus and hypothalamus

[meenaxi]

The answer is A. Intraparenchymal hemorrhage is typically due to hypertension, and is the most common cause of death from stroke. Such hemorrhages can occur at all of the sites listed in the answer choices, but roughly half of such cases involve the basal ganglia and internal capsule. Hypertensive hemorrhages are often massive and frequently dissect through the brain parenchyma into the ventricular system. There is frequently nothing a physician can do to prevent a fatal outcome in patients with massive intracerebral hemorrhage.

The other sites listed (choices B, C, D, and E) are important sites of intraparenchymal hemorrhage, but they are less frequently involved than the basal ganglia and the closely related internal capsule.