In a hypertensive hemorrhagic stroke, which region is most commonly affected?

In the context of a hypertensive hemorrhagic stroke, the putamen is most commonly affected due to its vascular supply. This region is part of the basal ganglia, which is particularly susceptible to microangiopathic changes caused by chronic hypertension. The putamen receives blood from the lenticulostriate arteries, which are small branches of the middle cerebral artery. In states of chronic high blood pressure, these small vessels can undergo hyaline arteriosclerosis, making them vulnerable to rupture during a hypertensive crisis.

When a hemorrhage occurs, it is often seen in deeper structures of the brain, with the putamen being a frequent site due to its location and vascular characteristics. This pattern is supported by clinical studies showing that hypertensive bleeds predominantly affect the basal ganglia and thalamus, with the putamen being the most involved.

While other regions, such as the frontal and parietal lobes, can also be affected by hemorrhagic strokes, especially in the context of aneurysms or arteriovenous malformations, they are less commonly associated with hypertensive hemorrhages. The cerebellum, similarly, can be impacted but is not as commonly a site for initial hypertensive bleeds compared to the putamen