USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

What is the most common cause of Spontaneous Intracranial Hemorrhage?

1. Hypertension

2. Atherosclerosis

3. AV malformations

4. Alcohol abuse

The correct answer is: AV malformations

The most common cause of spontaneous intracranial hemorrhage is hypertension. Chronic high blood pressure leads to changes in blood vessels in the brain, making them more susceptible to rupture. This can result in a hemorrhage, especially in the context of small vessel disease, where small penetrating arteries are weakened over time. Hypertension accounts for a significant proportion of intracranial hemorrhages, particularly intracerebral hemorrhages. Although arteriovenous malformations (AV malformations) can cause spontaneous hemorrhages, they are much less common than hypertension as a cause. Atherosclerosis can lead to hemorrhage as well, but it is primarily associated with ischemic strokes rather than spontaneous hemorrhagic events. Alcohol abuse can increase the risk of hemorrhage, particularly with heavy or chronic use, but it does not stand as the most common cause compared to the prevalence of hypertension in patient populations.