April 18, 2022 Case of the Week

Middle-aged man with focal neurology.
What are these finding most likely consistent with?
Can you comment on patient risk factors?
What is the most common anatomic site for this process?

Answer: Large unilateral territorial (MCA) bleed. Likely parenchymal hemorrhage due to hypertensive angiopathy. This pattern results from rupture of small, penetrating arteries and the most frequent sites are the basal ganglia and thalamus.
Notice the thin surface of normal tissue around the bleed, which makes a contusion a less likely explanation.