When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Hemorrhagic stroke

Última revisión: 13 Feb 2025
Última actualización: 12 Mar 2024

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • 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
Todos los datos

Factores de riesgo

  • 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
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • 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
Todos los datos

Pruebas diagnósticas que deben considerarse

  • 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
Todos los datos

Algoritmo de tratamiento

Inicial

presumed hemorrhagic stroke

Agudo

noncerebellar bleed: stable and alert

noncerebellar bleed: decompensating

<3 cm cerebellar bleed: alert

>3 cm cerebellar bleed or drowsy/unstable

Colaboradores

Autores

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

Divulgaciones

FDG declares that he has no competing interests.

Raisa C. Martinez, MD

Neurocritical Care Unit

Department of Neurosciences

Wellstar Health System, Kennestone

Marietta

GA

Divulgaciones

RCM declares that she has no competing interests.

Agradecimientos

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 topic.

Divulgaciones

EES is an author of a number of references cited in this topic. AH and TDF declare that they have no competing interests.

Revisores por pares

Louis R. Caplan, MD

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

Divulgaciones

LRC declares that he has no competing interests.

Julien Morier, MD

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Divulgaciones

JM declares that he has no competing interests.

  • Hemorrhagic stroke images
  • Diferenciales

    • Ischemic stroke
    • Hypertensive encephalopathy
    • Hypoglycemia
    Más Diferenciales
  • Guías de práctica clínica

    • Canadian Stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 7th edition
    • Clinical guidelines for stroke management
    Más Guías de práctica clínica
  • პაციენტის ბროშურები

    Stroke caused by a blood clot: preventing another stroke

    Stroke: treatment

    მეტი პაციენტის ბროშურები
  • კალკულატორები

    NIH Stroke Score

    მეტი კალკულატორები
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    How to perform an ECG: animated demonstration

    მეტი ვიდეოები
  • padlock-lockedშედით სისტემაში ან გამოიწერეთ BMJ Best Practice

ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას