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Hemorrhagic stroke

最后审阅: 15 Oct 2025
最后更新: 23 Apr 2025

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
完整详情

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
完整详情

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
完整详情

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
完整详情

治疗流程

初步治疗

presumed hemorrhagic stroke

急症处理

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.

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Referências

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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.
  • Hemorrhagic stroke images
  • Diagnósticos diferenciais

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    • Hypertensive encephalopathy
    • Hypoglycemia
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  • Diretrizes

    • Canadian Stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 7th edition
    • Clinical guidelines for stroke management
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  • Folhetos informativos para os pacientes

    Stroke caused by a blood clot: preventing another stroke

    Stroke: treatment

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  • კალკულატორები

    NIH Stroke Score

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