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
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
利益声明
FDG declares that he has no competing interests.
Raisa C. Martinez, MD
Neurocritical Care Unit
Department of Neurosciences
Wellstar Health System, Kennestone
Marietta
GA
利益声明
RCM declares that she has no competing interests.
鸣谢
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.
利益声明
EES is an author of a number of references cited in this topic. AH and TDF declare that they have no competing interests.
同行评议者
Louis R. Caplan, MD
Lecturer in Neurology
Hospital Chief
Cerebrovascular/Stroke Division
Beth Israel Deaconess Medical Center
Division of Cerebrovascular/Stroke
Boston
MA
利益声明
LRC declares that he has no competing interests.
Julien Morier, MD
Neurology Registrar
Neurology Service
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne
Switzerland
利益声明
JM declares that he has no competing interests.
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