Last reviewed: 3 Nov 2020
Last updated: 06 Oct 2020

Summary

Definition

History and exam

Key diagnostic factors

  • unilateral weakness or paralysis in the face, arm, or leg
  • sensory loss (numbness)
  • dysphasia
  • dysarthria
  • visual disturbance
  • photophobia
  • headache
  • ataxia
  • risk factors

Other diagnostic factors

  • vertigo
  • nausea/vomiting
  • decreased level of consciousness/coma
  • confusion
  • gaze paresis

Risk factors

  • hypertension
  • older age
  • male sex
  • Asian, black and/or Hispanic
  • heavy alcohol use
  • illicit sympathomimetic drugs
  • family history of intracerebral haemorrhage
  • haemophilia
  • cerebral amyloid angiopathy
  • autosomal dominant mutations in the COL4A1 gene
  • hereditary haemorrhagic telangiectasia
  • autosomal dominant mutations in the KRIT1 gene, CCM2 gene, or PDCD10 gene
  • anticoagulation
  • vascular malformations
  • Moyamoya disease
  • smoking
  • non-steroidal anti-inflammatories (NSAIDs)
  • diabetes mellitus
  • sympathomimetic medications
  • cerebral vasculitis
  • thrombocytopenia
  • leukaemia

Diagnostic investigations

1st investigations to order

  • non-contrast CT head
  • serum glucose
  • serum electrolytes
  • serum urea and creatinine
  • liver function tests
  • FBC
  • clotting screen
  • ECG
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

Disclosures

MJ declares that he has no competing interests.

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Fernando D. Goldenberg, MD

Clinical Associate of Neurology

Medical Director, Neuroscience ICU

Director, Neurocritical Care Education

Co-Director, Stroke Center

University of Chicago

Chicago

IL

Raisa C. Martinez, MD

Neurocritical Care Fellow

Department of Neurology

University of Chicago

Chicago

IL

Disclosures

FDG and RCM declare that they have no competing interests.

Peer reviewersVIEW ALL

Professor of Clinical Neurology

Head of Research Department, Brain Repair and Rehabilitation

UCL Institute of Neurology

Honorary Consultant Neurologist

National Hospital for Neurology and Neurosurgery

University College Hospitals NHS Foundation Trust 

North Thames Clinical Research Specialty Lead for Stroke

NIHR Clinical Research Network

London

UK

Disclosures

DW has received honoraria (speaking) from Bayer 2016, 2017, 2018 (talks or debates on intracerebral haemorrhage, atrial fibrillation, dementia) and honoraria (chairing) from Portola and Bayer 2019. DW has received consultancy fees from Bayer (2017; embolic stroke of undetermined source), JFB consulting (2018; PCSK9 inhibitors in stroke), Alnylam (2019; cerebral amyloid angiopathy), Portola (2019, 2020; andexanet alpha). JW was UCL Principle Investigator for NIHR clinical trials NAVIGATE-ESUS (Bayer, 2016-19), B2341002 (Pfizer 2014-2016), Action-2 (Biogen, 2016-19); Chief Investigator for OPTIMAS; steering committee and co-investigator for RESTART, TICH-2. 

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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