From the Research
The Anterior Communicating Artery (ACA) is not the primary artery associated with cerebral hemorrhage, but rather the lenticulostriate artery, a small penetrating branch of the middle cerebral artery (MCA), is more commonly linked to hemorrhagic strokes due to its anatomical features and vulnerability to rupture 1, 2, 3, 4, 5. The lenticulostriate artery supplies blood to deep brain structures including the internal capsule, basal ganglia, and particularly the putamen. Its small caliber and direct branching from the larger MCA at a nearly right angle create significant hemodynamic stress, making it prone to rupture. Additionally, these arteries are end arteries with minimal collateral circulation, lacking anastomoses with other vessels that could provide alternative blood flow. Hypertension particularly affects these vessels because they are directly exposed to high arterial pressures without the gradual reduction in pressure that occurs in vessels with more branching. When hypertension damages the vessel wall, the resulting hemorrhage often affects the basal ganglia and internal capsule, leading to contralateral hemiparesis, sensory deficits, and other significant neurological impairments. Key points to consider in the management and prevention of such strokes include:
- Aggressive blood pressure management to prevent vessel wall damage
- Consideration of underlying structural vascular abnormalities in young patients or those without known hypertension presenting with deep intracerebral hemorrhage
- The importance of delayed imaging to identify initially occult cerebrovascular lesions after hemorrhage
- The potential for surgical or endovascular treatment of identified aneurysms or other vascular lesions. In clinical practice, prioritizing the identification and management of hypertension, alongside thorough diagnostic workup in cases of intracerebral hemorrhage, is crucial for reducing morbidity, mortality, and improving quality of life in patients at risk of or affected by hemorrhagic strokes 5.