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Long-standing high blood pressure is still the most common cause of bleeding into the brain tissue (intraparenchymal hemorrhage, IPH) worldwide.


Hypertensive IPH most commonly occur in deeper regions of the brain such as basal ganglia, thalamus and brainstem. Other risk factors such as diabetes mellitus, smoking, alcohol use also play a role. The end-result of these risk factors and hypertension is disease of the small vessels in deeper parts of the brain. Consequently microaneurysms (tiny balooning of the vessel walls) can form and both symptomatic brain bleeds or tiny "microbleeds" can be seen at these locations. Similar to CAA, hypertensive small vessel disease can also result in ischemic (low-flow related) lesions such as white matter disease and small infarcts (lacunes or microinfarcts). 

Blood pressure control and avoidance of strong blood thinners are mainstays of prevention in patients who have hypertensive small vessel disease. There are situations where anticoagulants or their alternatives need to be considered (see Atrial Fibrillation part of this website as an example).

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