Summary
Definition
History and exam
Key diagnostic factors
- 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
Risk factors
- 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
Diagnostic investigations
1st investigations to order
- 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
Investigations to consider
- 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
Treatment algorithm
疑诊出血性卒中
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
Contributors
Authors
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
Disclosures
FDG declares that he has no competing interests.
Raisa C. Martinez, MD
Neurocritical Care Fellow
Department of Neurology
University of Chicago
Chicago
IL
Disclosures
RCM declares that she has no competing interests.
Acknowledgements
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.
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.
Differentials
- 缺血性卒中
- 高血压性脑病
- 低血糖
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