Adjacent Infarction in the Lenticulostriate Artery Territory Associated With Hypertensive Putaminal Hemorrhage: A Case Report

Acute ischemic lesions are occasionally detected in patients with intracerebral hemorrhage, but they are usually remote from the hematoma. Acute infarction adjacent to hypertensive putaminal hemorrhage is extremely rare. We report a 52-year-old man with untreated hypertension who presented with right upper extremity weakness, gait unsteadiness, and left temporal headache. Computed tomography showed a left putaminal hematoma with surrounding edema and a subtle adjacent hypoattenuating area. Magnetic resonance imaging demonstrated an acute infarction adjacent to the superomedial aspect of the hematoma, extending toward the left corona radiata within the lenticulostriate artery territory. No major arterial stenosis, vascular malformation, cardioembolic source, coagulopathy, or vasculitis was identified. His symptoms gradually improved with antihypertensive therapy. The mechanism remains uncertain, but hematoma-related local compression or hypoperfusion and concomitant hypertensive small vessel pathology may have contributed to the adjacent infarction. This case highlights the importance of differentiating hematoma-associated adjacent infarction from hemorrhagic transformation of ischemic stroke.