A 66 year-old man with a long standing history of hypertension presented with mild left sided weakness. There was no headache or change in mental state. The initial clinical diagnosis was probable lacunar stroke in internal capsule.

CT scan of the head. Note the intracerebral hemorrhage originating in the area of the basal ganglia on right. In the era before CT scanning, intracerebral hemorrhages were thought always to be catastrophic neurologic events. However, small hemorrhages can mimic ischemic strokes. This underscores the need to obtain a CT scan in every stroke patient to exclude the possibility of hemorrhage, especially before antiplatelet or anticoagulation is considered.