Hemorrhagic stroke resident survival guide: Difference between revisions

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==Definitions==
==Definitions==
===Hemorrhagic Stroke===
Hemorrhagic stroke is defined as rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma.  It is important to note that only '''non-traumatic causes''' of CNS hemorrhages are classified as stroke.  Hemorrhagic stroke consists of:
====Intracerebral Hemorrhage (ICH)==== 
This is defined as a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma.  Therefore, it consists of:
* [[Intraparenchymal hemorrhage]]
* [[Intraventricular hemorrhage]]
* Parenchymal hemorrhages following CNS infarction<ref name="Trouillas-2006">{{Cite journal  | last1 = Trouillas | first1 = P. | last2 = von Kummer | first2 = R. | title = Classification and pathogenesis of cerebral hemorrhages after thrombolysis in ischemic stroke. | journal = Stroke | volume = 37 | issue = 2 | pages = 556-61 | month = Feb | year = 2006 | doi = 10.1161/01.STR.0000196942.84707.71 | PMID = 16397182 }}</ref>
::Type I - confluent hemorrhage limited to ≤30% of the infarcted area with only mild space-occupying effect.
::Type II - >30% of the infarcted area and/or exerts a significant space-occupying effect.
====Subarachnoid Hemorrhage (SAH)====
This is defined as bleeding into the [[subarachnoid space]] (the space between the arachnoid membrane and the pia mater of the brain or spinal cord).  This consists of:
* Aneurysmal SAH
* Non-aneurysmal SAH
====Time of Onset====
Time of onset is defined as when the patient was last awake and symptom-free or known to be “normal".<ref name="Jauch-2013">{{Cite journal  | last1 = Jauch | first1 = EC.| last2 = Saver | first2 = JL. | last3 = Adams | first3 = HP. | last4 = Bruno | first4 = A. | last5 = Connors | first5 = JJ. | last6 = Demaerschalk | first6 = BM. | last7 = Khatri | first7 = P.| last8 = McMullan | first8 = PW. | last9 = Qureshi | first9 = AI. | title = Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. | journal = Stroke | volume = 44 | issue = 3 | pages = 870-947 | month = Mar | year = 2013 | doi = 10.1161/STR.0b013e318284056a | PMID = 23370205 }}</ref>


==Causes==
==Causes==

Revision as of 18:24, 11 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

Definitions

Hemorrhagic Stroke

Hemorrhagic stroke is defined as rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma. It is important to note that only non-traumatic causes of CNS hemorrhages are classified as stroke. Hemorrhagic stroke consists of:

Intracerebral Hemorrhage (ICH)

This is defined as a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma. Therefore, it consists of:

Type I - confluent hemorrhage limited to ≤30% of the infarcted area with only mild space-occupying effect.
Type II - >30% of the infarcted area and/or exerts a significant space-occupying effect.

Subarachnoid Hemorrhage (SAH)

This is defined as bleeding into the subarachnoid space (the space between the arachnoid membrane and the pia mater of the brain or spinal cord). This consists of:

  • Aneurysmal SAH
  • Non-aneurysmal SAH

Time of Onset

Time of onset is defined as when the patient was last awake and symptom-free or known to be “normal".[2]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

  • All the causes of stroke are life-threatening.

Common Causes

Management

Diagnosis

 
 
 
 
 
Check vitals
Stabilize ABC
Brief Hx
Rapid physical exam - neuro exam, NIHSS
Activate stroke team
Stat fingerstick
Basic labs, troponin, EKG
NPO
Obtain stroke protocol
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-contrast CT (or MRI)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bleed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
 
 
Negative
 
Ischemic Stroke
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Intracerebral Hemorrhage
 
Subarachnoid Hemorrhage
 
Strong Suspicion for SAH
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Management of ICH
 
 
 
 
 
 
May consider lumber puncture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Management of SAH
 
Xanthochromia or bloody CSF
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
No SAH
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Strong Suspicion for SAH
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Traumatic tap?
Poor Technique?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CTA/MRA
Consult to Neurosurgeon
Talk with superior
 
Normal CSF
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain more Hx and Investigation
Rule out other causes
Analgesia
 
 
 

Intracerebral Hemorrhage

Coagulopathy

Blood Pressure

Elevated Intracranial Pressure

Subarachnoid Hemorrhage

Dos

Don'ts

References

  1. ↑ Trouillas, P.; von Kummer, R. (2006). "Classification and pathogenesis of cerebral hemorrhages after thrombolysis in ischemic stroke". Stroke. 37 (2): 556–61. doi:10.1161/01.STR.0000196942.84707.71. PMID 16397182. Unknown parameter |month= ignored (help)
  2. ↑ Jauch, EC.; Saver, JL.; Adams, HP.; Bruno, A.; Connors, JJ.; Demaerschalk, BM.; Khatri, P.; McMullan, PW.; Qureshi, AI. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205. Unknown parameter |month= ignored (help)

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