A 45-year-old man with chronic hypertension develops sudden onset left-sided weakness and slurred speech. His CT head shows a deep intracerebral hemorrhage in the basal ganglia. What is the most likely underlying pathophysiological mechanism? A) Amyloid angiopathy B) Hyaline arteriolosclerosis C) Cerebral venous thrombosis D) Aneurysmal rupture E) Small vessel vasculitis Correct Answer: B) Hyaline arteriolosclerosis Explanation: Chronic hypertension → Small vessel disease → Hyaline arteriolosclerosis → Predisposes to deep intracerebral hemorrhages (e.g., basal ganglia, thalamus, pons). Amyloid angiopathy (A) causes lobar hemorrhages in elderly patients. Cerebral venous thrombosis (C) causes headache + seizures, not hypertensive hemorrhage. Aneurysmal rupture (D) leads to subarachnoid hemorrhage (SAH), not deep ICH. Small vessel vasculitis (E) is rare and does not typically cause deep hemorrhages. Key Tips for PLAB 1: ✅ Hypertensive hemorrhage → Basal ganglia, thalamus, pons ✅ Pathophysiology = Hyaline arteriolosclerosis ✅ Risk factor = Chronic hypertension
