Most commonly caused by systemic hypertension. - Also seen with amyloid angiopathy (recurrent lobar hemorrhagic stroke in elderly), vasculitis, neoplasm. - May be 2° to reperfusion injury in ischemic stroke.

- Hypertensive hemorrhages (Charcot-Bouchard microaneurysm) most often occur in putamen of basal ganglia (lenticulostriate vessels), followed by thalamus, pons, and cerebellum.