Autopsy of a hypeensive 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?
Intraparenchymal hemorrhage is typically due to hypeension, 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. Hypeensive 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 are impoant sites of intraparenchymal hemorrhage, but they are less frequently involved than the basal ganglia and the closely related internal capsule. Ref: Smith W.S., English J.D., Johnston S.C. (2012). Chapter 370. Cerebrovascular Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
Basal ganglia and internal capsule
Central white matter
Cerebellum and medulla
Pons