Commonest site of Hypertensive bleed is?
Pons
Putamen
Frontal lobe
Thalamus
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
Cerebrovascular