Most common region affected by hemorrhagic stroke?

• A. Thalamus
• B. Cerebellum
• C. Putamen
• D. Brainstem

Answer: (C)

Bleeding in hypertensive intracerebral hemorrhage most commonly occurs in the putamen. Chronic hypertension damages small penetrating vessels, particularly the lenticulostriate arteries from the middle cerebral artery, leading to lipohyalinosis and Charcot-Bouchard microaneurysms. When these fragile vessels rupture, the putamen receives the brunt of the hemorrhage more often than other deep structures. Clinically, this site typically produces abrupt focal deficits with contralateral motor and sensory involvement, and can be accompanied by gaze abnormalities or headache. The thalamus is a common alternative site, but the putamen remains the most frequent region affected, with cerebellar and brainstem hemorrhages being less common.