Arterial Hypertension (AHT) is currently the main modifiable risk factor for cerebrovascular disease and a common cause of hypertensive emergencies in our environment, however, other etiologies exist in patients who persist with neurological alterations. The case of a 49-year-old patient with poorly controlled AHT who was admitted due to a hypertensive emergency presenting as stroke (ictus) is presented. Magnetic resonance imaging (MRI) showed an acute hemorrhagic lesion in the caudate nucleus. This lesion did not explain all the physical examination findings, but the susceptibility-weighted sequence evidenced multiple microhemorrhages with universal distribution (cortico-subcortical and deep). The location of the lesions presents a diagnostic dilemma between Hypertensive Microangiopathy (ECPV- AHT), which predominantly affects deep structures (deep nuclei and brainstem), and Cerebral Amyloid Microangiopathy (CAM), which affects the lobes (cortical or subcortical). The case underscores the importance of imaging (imagenología), specifically MRI, for the detection of cerebral microhemorrhages, and highlights the possibility of the coexistence or overlap of both vasculopathies in the context of Cerebral Small Vessel Disease.