Haemorrhagic Stroke

Question 1

Define haemorrhagic stroke.

Answer 1

Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology.

Question 2

Explain the aetiology/risk factors of haemorrhagic stroke.

Answer 2

Hypertension
Advanced age
Male sex
Asian, black and/or Hispanic
Family history of haemorrhagic stroke
Haemophilia
Cerebral amyloid angiopathy
Anticoagulation

Question 3

Summarise the epidemiology of haemorrhagic stroke.

Answer 3

Stroke is the third leading cause of death and a major cause of disability in the US and in England and Wales. Haemorrhagic strokes account for 15% of all strokes.

Question 4

Recognise the presenting symptoms of haemorrhagic stroke. Recognise the signs of haemorrhagic stroke on physical examination.

Answer 4

Neck stiffness
History of atrial fibrillation
History of liver disease
Visual changes
Photophobia
Sudden onset
Altered sensation
Headache
Weakness
Sensory loss
Aphasia
Dysarthria
Ataxia

Question 5

Identify appropriate investigations for haemorrhagic stroke and interpret the results.

Answer 5

Non-infused head CT
Chemistry panel
FBC
Clotting tests
ECG
Platelet function test
Urine drug screen
Pregnancy test in women of childbearing age
Liver function test
Intracerebral haemorrhage (ICH) Score

Question 6

Generate a management plan for haemorrhagic stroke.

Answer 6

Neurosurgical and neurocritical care evaluation

Plus:
Admission to neuroscience ICU or stroke unit
Airway protection
Aspiration precautions

Question 7

Identify the possible complications of haemorrhagic stroke and its management.

Answer 7

Deep venous thrombosis
Infection
Seizures
Delirium
Aspiration pneumonia
Hydrocephalus

Question 8

Summarise the prognosis for patients with haemorrhagic stroke.

Answer 8

Mortality is significantly higher than for ischaemic stroke, in the range of 35% to 40%. Only 20% to 30% of all patients are well enough to live independently by 3 to 6 months.