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AVC hemorrágico

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 20 Aug 2025
Last updated: 23 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • rigidez de nuca
  • história de fibrilação atrial
  • história de doença hepática
  • alterações visuais
  • fotofobia
  • início súbito seguido de progressão
  • alterações sensitivas
  • cefaleia
  • fraqueza
  • perda sensitiva
  • afasia
  • disartria
  • ataxia
  • história de distúrbios hematológicos
  • vertigem
  • náuseas/vômitos
  • nível alterado de consciência ou coma
  • confusão
  • paresia da mirada
Full details

Risk factors

  • hipertensão
  • idade avançada
  • sexo masculino
  • Asiáticos, negros e/ou etnia hispânica
  • história familiar de AVC hemorrágico
  • hemofilia
  • angiopatia amiloide cerebral
  • doença falciforme
  • mutações autossômicas dominantes no gene COL4A1
  • telangiectasia hemorrágica hereditária
  • mutações autossômicas dominantes nos genes KRIT1, CCM2 ou PDCD10
  • anticoagulação
  • drogas simpatomiméticas ilícitas
  • malformações vasculares
  • tabagismo
  • anti-inflamatórios não esteroidais (AINEs)
  • apneia obstrutiva do sono
  • diabetes mellitus
  • abuso intenso de álcool
  • vasculite cerebral
  • trombocitopenia
  • sono de duração longa ou má qualidade do sono
  • doença de Moyamoya
  • gestação
  • leucemia
Full details

Diagnostic tests

1st tests to order

  • tomografia computadorizada (TC) de crânio sem contraste
  • perfil bioquímico
  • Hemograma completo
  • testes de coagulação
  • eletrocardiograma (ECG)
  • teste da função plaquetária
  • exame de urina para detecção de drogas
  • teste de gravidez em mulheres em idade fértil
  • teste da função hepática
  • escore de hemorragia intracerebral (HIC)
Full details

Tests to consider

  • angiotomografia e venografia
  • angiografia por ressonância magnética e venografia
  • angiografia convencional (invasiva)
  • ressonância nuclear magnética (RNM) cerebral
  • ressonância nuclear magnética (RNM) cranioencefálica com imagem ponderada por difusão (DWI) e sequência de ecogradiente (GRE)
  • RNM cranioencefálica com imagem por susceptibilidade ponderada
Full details

Treatment algorithm

INITIAL

acidente vascular cerebral (AVC) hemorrágico presumido

ACUTE

sangramento não cerebelar: estável e alerta

sangramento não cerebelar: descompensado

sangramento cerebelar <3 cm: alerta

sangramento cerebelar >3 cm ou sonolento/instável

Contributors

Authors

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

Disclosures

LRC declares that he has no competing interests.

Julien Morier, MD

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Disclosures

JM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

Intercollegiate Stroke Working Party. ​The National clinical guideline for stroke for the United Kingdom and Ireland. Apr 2023 [internet publication].Full text

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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