Commonest site of Hypertensive bleed is?
ANSWER: (B) PutamenREF: Harrisons Internal Medicine 17thedition Chapter 364. Cerebrovascular Diseases Table 364-5"Hypertensive intraparenchymal hemorrhage (Hypertensive hemorrhage or Hypertensive intracerebral hemorrhage) usually results from spontaneous rupture of a small penetrating artery deep in the brain. The most common sites are the basal ganglia (especially the Putamen), thalamus, cerebellum, and pons"CAUSES OF INTRACRANIAL HEMORRHAGECauseLocationCommentsHead traumaIntraparenchymal: frontal lobes, anterior temporal lobes; subarachnoidCoup and contracoup injury during brain decelerationHypertensivehemorrhagePutamen, globus pallidus, thalamus, cerebellar hemisphere, ponsChronic hypertension produces hemorrhage from small (-100 m) vessels in these regionsTransformation of prior ischemic infarctionBasal ganglion, subcortical regions, lobarOccurs in 1-6% of ischemic strokes with predilection for large hemispheric infarctionsMetastatic brain tumorLobarLung, choriocarcinoma, melanoma, renal cell carcinoma, thyroid, atrial myxomaCoagulopathyAnyUncommon cause; often associated with prior stroke or underlying vascular anomalyDrugLobar, subarachnoidCocaine, amphetamine, phenvlpropranolamineArteriovenousmalformationLobar, intraventricular, subarachnoidRisk is -2-4% per year for bleedingAneurysmSubarachnoid, intraparenchymal, rarely subduralMycotic and nonmycotic forms of aneurysmsAmyloid angiopathyLobarDegenerative disease of intracranial vessels; linkage to Alzheimer's disease, rare in patients <60Cavernous angiomaIntraparenchymalMultiple cavernous angiomas linked to mutations in KRIT1, CCM2, and PDCD10 genesDural arteriovenous hstulaLobar, subarachnoidProduces bleeding by venous hypertensionCapillary telangiectasiasUsually brainstemRare cause of hemorrhage
Pons
Putamen
Frontal lobe
Thalamus
Cerebrovascular