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Intracerebral haemorrhage — SCE Neurology MCQ

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ModerateStrokeIntracerebral haemorrhageSCE Neurology

A 31-year-old woman presented with sudden severe headache, vomiting and left hemiparesis while anticoagulated. On examination, blood pressure was 220/110 mmHg with reduced conscious level. Initial investigations showed: CT showed a right basal ganglia hyperdensity with intraventricular extension. What is the most likely underlying mechanism?

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Correct answer: E — hypertensive arteriolar rupture

hypertensive arteriolar rupture is the best answer because the vignette describes Intracerebral haemorrhage: deep hyperdense bleed in hypertension is intracerebral haemorrhage. Small-vessel lipohyalinosis is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Immune-mediated inflammatory demyelination and Prion protein misfolding are less appropriate because they would require different localisation, timing or test findings; Paradoxical embolism through a right-to-left shunt would fit a different syndrome. Clinical pearl: ischaemic stroke thrombolysis would be dangerous without excluding haemorrhage.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive