Hemorrhagic stroke history and symptoms

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

Overview

History and symptoms

History

It is critical to obtain a detailed and focused history.^[1]^[2]^[3]^[4]^[5]^[6]


History	Comments
Timing of the symptoms onset	The time the patient was last normal
Initial symptoms	The progression of symptoms
Vascular risk factors	Hypertension Diabetes Hypercholesterolemia Smoking
Medications	Anticoagulants Antiplatelet agents Decongestants Antihypertensive medications Stimulants (including diet pills) Sympathomimetics
Recent trauma or surgery	ICH may be related to hyperperfusion after Carotid endarterectomy Carotid stenting
Dementia	Associated with amyloid angiopathy
Alcohol or illicit drug use	Cocaine Other sympathomimetic drugs
Liver disease	Associated with coagulopathy
Cancer and hematologic disorders	Associated with coagulopathy

Symtoms

It is impossible to know whether symptoms are due to ischemia or hemorrhage based on clinical characteristics alone. The abrupt onset of focal neurologic symptoms is presumed to be vascular in origin.

Non specific symptoms of hemorrhagic stroke may include the following:^[7]^[8]

References

↑ Huhtakangas J, Tetri S, Juvela S, Saloheimo P, Bode MK, Hillbom M. Effect of increased warfarin use on warfarin-related cerebral hemor- rhage: a longitudinal population-based study. Stroke. 2011;42:2431– 2435. doi: 10.1161/STROKEAHA.111.615260.
↑ Rådberg JA, Olsson JE, Rådberg CT. Prognostic parameters in sponta- neous intracerebral hematomas with special reference to anticoagulant treatment. Stroke. 1991;22:571–576. doi: 10.1161/01.STR.22.5.571.
↑ Flaherty ML, Kissela B, Woo D, Kleindorfer D, Alwell K, Sekar P, Moomaw CJ, Haverbusch M, Broderick JP. The increasing incidence of anticoagulant-associated intracerebral hemorrhage. Neurology. 2007;68:116–121. doi: 10.1212/01.wnl.0000250340.05202.8b.
↑ Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003). “Risk factors for intracerebral hemorrhage in the general population: a systematic review”. Stroke. 34 (8): 2060–5. doi:10.1161/01.STR.0000080678.09344.8D. PMID 12843354.
↑ Bos MJ, Koudstaal PJ, Hofman A, Breteler MM (2007). “Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study”. Stroke. 38 (12): 3127–32. doi:10.1161/STROKEAHA.107.489807. PMID 17962600.
↑ Hackam DG, Mrkobrada M (2012). “Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis”. Neurology. 79 (18): 1862–5. doi:10.1212/WNL.0b013e318271f848. PMID 23077009. Review in: Evid Based Ment Health. 2013 May;16(2):54
↑ Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001). “Spontaneous intracerebral hemorrhage”. N Engl J Med. 344 (19): 1450–60. doi:10.1056/NEJM200105103441907. PMID 11346811.
↑ Fisher CM (1971). “Pathological observations in hypertensive cerebral hemorrhage”. J Neuropathol Exp Neurol. 30 (3): 536–50. PMID 4105427.

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[Huhtakangas-1] Huhtakangas J, Tetri S, Juvela S, Saloheimo P, Bode MK, Hillbom M. Effect of increased warfarin use on warfarin-related cerebral hemor- rhage: a longitudinal population-based study. Stroke. 2011;42:2431– 2435. doi: 10.1161/STROKEAHA.111.615260.

[Rådberg-2] Rådberg JA, Olsson JE, Rådberg CT. Prognostic parameters in sponta- neous intracerebral hematomas with special reference to anticoagulant treatment. Stroke. 1991;22:571–576. doi: 10.1161/01.STR.22.5.571.

[Flaherty-3] Flaherty ML, Kissela B, Woo D, Kleindorfer D, Alwell K, Sekar P, Moomaw CJ, Haverbusch M, Broderick JP. The increasing incidence of anticoagulant-associated intracerebral hemorrhage. Neurology. 2007;68:116–121. doi: 10.1212/01.wnl.0000250340.05202.8b.

[pmid12843354-4] Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003). “Risk factors for intracerebral hemorrhage in the general population: a systematic review”. Stroke. 34 (8): 2060–5. doi:10.1161/01.STR.0000080678.09344.8D. PMID 12843354.

[pmid17962600-5] Bos MJ, Koudstaal PJ, Hofman A, Breteler MM (2007). “Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study”. Stroke. 38 (12): 3127–32. doi:10.1161/STROKEAHA.107.489807. PMID 17962600.

[pmid23077009-6] Hackam DG, Mrkobrada M (2012). “Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis”. Neurology. 79 (18): 1862–5. doi:10.1212/WNL.0b013e318271f848. PMID 23077009. Review in: Evid Based Ment Health. 2013 May;16(2):54

[pmid11346811-7] Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001). “Spontaneous intracerebral hemorrhage”. N Engl J Med. 344 (19): 1450–60. doi:10.1056/NEJM200105103441907. PMID 11346811.

[pmid4105427-8] Fisher CM (1971). “Pathological observations in hypertensive cerebral hemorrhage”. J Neuropathol Exp Neurol. 30 (3): 536–50. PMID 4105427.

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