Summary
Definition
History and exam
Key diagnostic factors
- neck stiffness
- hx of atrial fibrillation
- hx of liver disease
- visual changes
- photophobia
- sudden onset
- altered sensation
- headache
- weakness
- sensory loss
- aphasia
- dysarthria
- ataxia
- hx of hematologic disorder
- vertigo
- nausea/vomiting
- altered level of consciousness/coma
- confusion
- gaze paresis
Risk factors
- advanced age
- male sex
- Asian, black and/or Hispanic
- FHx of hemorrhagic stroke
- hemophilia
- cerebral amyloid angiopathy
- autosomal dominant mutations in the COL4A1 gene
- hereditary hemorrhagic telangiectasia
- autosomal dominant mutations in the KRIT1 gene
- autosomal dominant mutations in the CCM2 gene
- autosomal dominant mutations in the PDCD10 gene
- HTN
- anticoagulation
- illicit sympathomimetic drugs
- vascular malformations
- smoking
- nonsteroidal anti-inflammatories (NSAIDs)
- diabetes mellitus
- heavy alcohol abuse
- sympathomimetic medications
- cerebral vasculitis
- thrombocytopenia
- Moyamoya disease
- leukemia
Diagnostic investigations
1st investigations to order
- non-infused head CT
- chemistry panel
- CBC
- clotting tests
- ECG
- platelet function test
- urine drug screen
- pregnancy test in women of childbearing age
- liver function test
- intracerebral hemorrhage (ICH) score
Investigations to consider
- CT angiography and venography
- magnetic resonance angiography and venography
- conventional (invasive) angiography
- MRI brain with diffusion-weighted imaging (DWI) and gradient-echo sequence (GRE)
- MRI brain with susceptibility-weighted imaging
Treatment algorithm
Contributors
Authors VIEW ALL
Clinical Associate of Neurology
Medical Director, Neuroscience ICU
Director, Neurocritical Care Education
Co-Director, Stroke Center
University of Chicago
Chicago
IL
Disclosures
FDG declares that he has no competing interests.
Neurocritical Care Fellow
Department of Neurology
University of Chicago
Chicago
IL
Disclosures
RCM declares that she has no competing interests.
Dr Fernando Goldenberg and Dr Raisa Martinez would like to gratefully acknowledge Dr Alejandro Hornik, Dr Eric E. Smith, and Dr T. Dion Fung, the previous contributors to this monograph. EES is an author of a number of references cited in this monograph. AH and TDF declare that they have no competing interests.
Peer reviewers VIEW ALL
Lecturer in Neurology
Hospital Chief
Cerebrovascular/Stroke Division
Beth Israel Deaconess Medical Center
Division of Cerebrovascular/Stroke
Boston
MA
Disclosures
LRC declares that he has no competing interests.
Neurology Registrar
Neurology Service
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne
Switzerland
Disclosures
JM declares that he has no competing interests.
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