Commonest site of Hypeensive bleed is?
Putamen REF: Harrison's Internal Medicine 17th edition Chapter 364. Cerebrovascular Diseases Table 364-5 "Hypeensive intraparenchymal hemorrhage (Hypeensive hemorrhage or Hypeensive intracerebral hemorrhage) usually results from spontaneous rupture of a small penetrating aery deep in the brain. The most common sites are the basal ganglia (especially the Putamen), thalamus, cerebellum, and pons" CAUSES OF INTRACRANIAL HEMORRHAGE Cause Location Comments Head trauma Intraparenchymal: frontal lobes, anterior Coup and contracoup injury during temporal lobes; subarachnoid brain deceleration Hypeensive hemorrhage Putamen, globus pallidus, thalamus, cerebellar hemisphere, pons Chronic hypeension produces hemorrhage from small (-100 m) vessels in these regions Transformation of prior Basal ganglion, subcoical regions, lobar Occurs in 1-6% of ischemic strokes ischemic infarction with predilection for large hemispheric infarctions Metastatic brain tumor Lobar Lung, choriocarcinoma, melanoma, renal cell carcinoma, thyroid, atrial myxoma Coagulopathy Any Uncommon cause; often associated with prior stroke or underlying vascular anomaly Drug Lobar, subarachnoid Cocaine, amphetamine, phenylpropranolamine Aeriovenous malformation Lobar, intraventricular, subarachnoid Risk is -2-4% per year for bleeding Aneurysm Subarachnoid, intraparenchymal, rarely subdural Mycotic and nonmycotic forms of aneurysms Amyloid angiopathy Lobar Degenerative disease of intracranial vessels; linkage to Alzheimer's disease, rare in patients <60 Cavernous angioma Intraparenchymal Multiple cavernous angiomas linked to mutations in KRIT1, CCM2, and PDCD10 genes Dural aeriovenous fistula Lobar, subarachnoid Produces bleeding by venous hypeension Capillary telangiectasias Usually brainstem Rare cause of hemorrhage
Pons
Putamen
Frontal lobe
Thalamus