Which type of stroke is typically caused by hypertension and presents with abrupt onset in deep brain structures such as the basal ganglia or thalamus?

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Hypertension causes damage to small penetrating arteries in the brain through a process called lipohyalinosis, weakening the vessel walls and making them prone to rupture. When these small deep arteries rupture, blood accumulates within the brain tissue itself, producing an intracerebral hemorrhage. The basal ganglia and thalamus are classic deep sites reached by these penetrating arteries (such as the lenticulostriate arteries from the MCA), so hemorrhages there produce abrupt, focal neurologic deficits that start suddenly.

In contrast, an ischemic stroke results from a vessel occlusion and typically shows a brain tissue infarct on imaging rather than a hematoma. Subarachnoid hemorrhage involves bleeding into the space surrounding the brain, usually from an aneurysm, and presents differently (often with a sudden, severe "thunderclap" headache and meningeal signs). A transient ischemic attack is a brief neurologic deficit without lasting damage or radiographic evidence of infarction. Therefore, the scenario described fits a hypertensive intracerebral hemorrhage in deep brain structures.