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.

出血性卒中

最后审阅: 3 Apr 2025
最后更新: 06 Dec 2018

小结

定义

病史和体格检查

关键诊断因素

  • 颈项强直
  • 心房颤动病史
  • 肝病病史
  • 视觉变化
  • 畏光
  • 突然发作
  • 感觉改变
  • 头痛
  • 虚弱
  • 感觉丧失
  • 失语症
  • 构音障碍
  • 共济失调
  • 血液病病史
  • 眩晕
  • 恶心/呕吐
  • 意识水平改变/昏迷
  • 意识模糊
  • 凝视麻痹
完整详情

危险因素

  • 高血压
  • 高龄
  • 男性
  • 亚裔、黑人和/或西班牙裔
  • 出血性卒中家族史
  • 血友病
  • 脑血管淀粉样变性
  • COL4A1 基因常染色体显性突变
  • 遗传性出血性毛细血管扩张症
  • KRIT1 基因常染色体显性突变
  • CCM2 基因常染色体显性突变
  • PDCD10 基因常染色体显性突变
  • 抗凝治疗
  • 滥用拟交感神经药物
  • 血管畸形
  • 吸烟
  • 非甾体抗炎药 (non-steroidal anti-inflammatories, NSAIDs)
  • 糖尿病
  • 重度酒精滥用
  • 拟交感神经药物
  • 脑血管炎
  • 血小板减少
  • 烟雾病
  • 白血病
完整详情

诊断性检查

首要检查

  • 非灌注头颅 CT 扫描
  • 化学检查
  • 全血细胞计数(FBC)
  • 凝血试验
  • 心电图(ECG)
  • 血小板功能检测
  • 尿液药物筛查
  • 育龄妇女妊娠试验
  • 肝功能检查
  • 脑出血 (ICH) 评分
完整详情

需考虑的检查

  • CT 血管造影和静脉造影
  • 磁共振血管造影和静脉造影
  • 传统的(侵入性)血管造影术
  • 头颅 MRI-弥散加权成像 (DWI) 和梯度回波序列 (GRE)
  • 头颅 MRI-磁敏感加权成像
完整详情

治疗流程

初步治疗

疑诊出血性卒中

急症处理

非小脑出血:病情稳定且清醒者

非小脑出血:失代偿

<3 cm 的小脑出血:意识清醒

>3 cm 的小脑出血或昏睡/生命体征不稳定

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 Fellow

Department of Neurology

University of Chicago

Chicago

IL

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 monograph. EES is an author of a number of references cited in this monograph. 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.

参考文献

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.

关键文献

Smith EE, Rosand J, Greenberg SM. Hemorrhagic stroke. Neuroimaging Clin N Am. 2005 May;15(2):259-72. 摘要

Smith EE, Greenberg SM. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Curr Atheroscler Rep. 2003 Jul;5(4):260-6. 摘要

Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry. 2017 Dec;88(12):1079-91. 摘要

Derdeyn CP, Zipfel GJ, Albuquerque FC, et al. Management of brain arteriovenous malformations: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017 Aug;48(8):e200-24.全文  摘要

Hemphill JC 3rd, Bonovich DC, Besmertis L, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001 Apr;32(4):891-7.全文  摘要

Takahashi JC, Funaki T, Houkin K, et al; JAM Trial Investigators. Significance of the hemorrhagic site for recurrent bleeding: prespecified analysis in the Japan Adult Moyamoya trial. Stroke. 2016 Jan;47(1):37-43. 摘要

Ma Y, Li Z, Chen L, et al. Blood lipid levels, statin therapy and the risk of intracerebral hemorrhage. Lipids Health Dis. 2016 Mar 1;15:43.全文  摘要

Hemphill JC 3rd, Greenberg SM, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-60.全文  摘要

Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005 Jan 29-Feb 4;365(9457):387-97. 摘要

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.全文  摘要

Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008 Jun;133(6 suppl):160-98S. 摘要

Garcia DA, Baglin TP, Weitz JI, et al. Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 suppl):e24-43S.全文  摘要

Rost NS, Smith EE, Chang Y, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008 Aug;39(8):2304-9.全文  摘要

Murthy SB, Gupta A, Merkler AE, et al. Restarting anticoagulant therapy after intracranial hemorrhage: a systematic review and meta-analysis. Stroke. 2017 Jun;48(6):1594-600.全文  摘要

Eckman MH, Rosand J, Knudsen KA, et al. Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis. Stroke. 2003 Jul;34(7):1710-6.全文  摘要

Katsanos AH, Mavridis D, Parissis J, et al. Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis. Ther Adv Neurol Disord. 2016 Sep;9(5):359-68.全文  摘要

Oertel LB, Fogerty AE. Use of direct oral anticoagulants for stroke prevention in elderly patients with nonvalvular atrial fibrillation. J Am Assoc Nurse Pract. 2017 Sep;29(9):551-61. 摘要

Tereshchenko LG, Henrikson CA, Cigarroa J, et al. Comparative effectiveness of interventions for stroke prevention in atrial fibrillation: a network meta-analysis. J Am Heart Assoc. 2016 May 20;5(5): e003206.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • 出血性卒中 images
  • 鉴别诊断

    • 缺血性卒中
    • 高血压性脑病
    • 低血糖
    更多 鉴别诊断
  • 指南

    • 16 岁以上卒中和短暂性脑缺血发作:诊断和初步治疗
    • 卒中管理临床指南
    更多 指南
  • 患者教育信息

    Stroke caused by a blood clot: preventing another stroke

    Stroke: treatment

    更多 患者教育信息
  • 医学计算器

    美国国立卫生研究院 (NIH) 卒中评分

    更多 医学计算器
  • Videos

    静脉穿刺和抽血的动画演示

    关于如何进行心电图的动画演示

    更多 操作视频
  • padlock-locked登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明