小结
定义
病史和体格检查
关键诊断因素
- neck stiffness
- history of atrial fibrillation
- history of liver disease
- visual changes
- photophobia
- sudden onset followed by progression
- altered sensation
- headache
- weakness
- sensory loss
- aphasia
- dysarthria
- ataxia
- history of hematologic disorder
- vertigo
- nausea/vomiting
- altered level of consciousness/coma
- confusion
- gaze paresis
危险因素
- hypertension
- advanced age
- male sex
- Asian, black, and/or Hispanic ethnicity
- family history of hemorrhagic stroke
- hemophilia
- cerebral amyloid angiopathy
- sickle cell disease
- autosomal dominant mutations in the COL4A1 gene
- hereditary hemorrhagic telangiectasia
- autosomal dominant mutations in the KRIT1, CCM2, or PDCD10 genes
- anticoagulation
- illicit sympathomimetic drugs
- vascular malformations
- smoking
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- obstructive sleep apnea
- diabetes mellitus
- heavy alcohol abuse
- cerebral vasculitis
- thrombocytopenia
- long sleep duration and poor sleep quality
- Moyamoya disease
- pregnancy
- leukemia
诊断性检查
首要检查
- noncontrast 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
需考虑的检查
- CT angiography and venography
- magnetic resonance angiography and venography
- conventional (invasive) angiography
- MRI brain
- MRI brain with diffusion-weighted imaging (DWI) and gradient-echo sequence (GRE)
- MRI brain with susceptibility-weighted imaging
治疗流程
presumed hemorrhagic stroke
noncerebellar bleed: stable and alert
noncerebellar bleed: decompensating
<3 cm cerebellar bleed: alert
>3 cm cerebellar bleed or drowsy/unstable
撰稿人
作者
Raisa C. Martinez, MD
Neurocritical Care Unit
Department of Neurosciences
Wellstar Health System, Kennestone
Marietta
GA
Disclosures
RCM declares that she has no competing interests.
Acknowledgements
Dr Raisa Martinez would like to gratefully acknowledge Dr Fernando D. Goldenberg, Dr Alejandro Hornik, Dr Eric E. Smith, and Dr T. Dion Fung, the previous contributors to this topic.
Disclosures
EES is an author of a number of references cited in this topic. FDG, AH, and TDF declare that they have no competing interests.
Peer reviewers
Louis R. Caplan, MD
Lecturer in Neurology
Hospital Chief
Cerebrovascular/Stroke Division
Beth Israel Deaconess Medical Center
Division of Cerebrovascular/Stroke
Boston
MA
Declarações
LRC declares that he has no competing interests.
Julien Morier, MD
Neurology Registrar
Neurology Service
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne
Switzerland
Declarações
JM declares that he has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
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Referências
Principais artigos
Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-361.Texto completo Resumo
Intercollegiate Stroke Working Party. The National clinical guideline for stroke for the United Kingdom and Ireland. Apr 2023 [internet publication].Texto completo
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-e467.Texto completo Resumo
Steiner T, Al-Shahi Salman R, Beer R, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014 Oct;9(7):840-55.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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