Intracerebral Hemorrhage Secondary to Chronic Left Middle Cerebral Artery Occlusion: Diagnostic Challenges and Clinical Implications

Intracerebral Hemorrhage (ICH) is a severe form of stroke with high morbidity and mortality. While Middle Cerebral Artery (MCA) occlusion typically results in ischemic infarction, ICH secondary to chronic MCA occlusion without concomitant ischemia is an exceedingly rare phenomenon that challenges both diagnosis and management. We report a 45-year-old male with multiple cardiovascular risk factors presenting with acute focal neurological deficit, which emphasizes the importance of considering chronic MCA occlusion as a potential etiology of ICH, even in the absence of infarction. Radiological evaluation, especially with magnetic resonance imaging, is essential to guide prevention and management strategies.