Hemorrhagic VS Ischemic
There are two fundamental subtypes of stroke, hemorrhagic and ischemic. Determining whether a stroke is hemorrhagic or ischemic has important implications not only for the patient's prognosis but also for decisions concerning surgery or anticoagulant treatment. Clinicians must be able to rapidly distinguish from these two subtypes because the treatment of one may be contraindicated for the other, for example, administering anticoagulants to a patient with a hemorrhagic stroke would only drastically worsen the situation. It is estimated, that in the United States, 87% of strokes are ischemic whereas 13% are hemorrhagic (Runchey, 2010).
Classic descriptions of stroke suggest that some clinical features may differentiate these subtypes:
Hemorrhagic
- Headache,
- Neck stiffness,
- Coma,
- Loss of consciousness,
- Vomiting,
- Smooth onset,
- Seizure accompanying neurological deficit, and
- Diastolic blood pressure greater than 110 mmHg
Ischemic
- Previous history of transient ischemic attacks,
- Atrial fibrillation,
- Sudden onset,
- Peripheral artery disease, and
- Atherosclerosis*
* Classic risk factors for cerebral atherosclerosis, including diabetes mellitus, elevated cholesterol, cigarette smoking, and hypertension, fail to distinguish the two subtypes of stroke either because the risk factor is only weakly associated with ischemic stroke or because the risk factor is linked to both subtypes thus eliminating diagnostic value (Runchey, 2010).
Clinical examination alone cannot reliably distinguish the two subtypes, brain imaging using computed tomography (CT) scans or magnetic resonance imaging (MRI). A CT scan is typically done acutely because it is more readily available and more expedient (Runchey, 2010).
Clinical examination alone cannot reliably distinguish the two subtypes, brain imaging using computed tomography (CT) scans or magnetic resonance imaging (MRI). A CT scan is typically done acutely because it is more readily available and more expedient (Runchey, 2010).
Images: http://www.neurosurgery.ufl.edu/patients/stroke.shtml