Hemorrhagic stroke - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Hemorrhagic stroke accounts for approximately 10% of strokes.
Computed tomography (CT) or magnetic resonance imaging (MRI), with high sensitivity for intracerebral hemorrhage, are essential in diagnosis.
The primary treatment for people with hemorrhagic stroke involves supportive care and optimization of intracranial hemodynamics.
Surgical resection of intracerebral hematomas may be of benefit in select cases, such as cerebellar hematomas >3 cm in diameter causing brain stem compression or hydrocephalus.
Patients treated in dedicated stroke units have improved survival and reduced disability at 1 year.

Intracranial hemorrhage on CT scan

Massachusetts General Hospital personal case files; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Intracranial hemorrhage on CT scan
Spot sign on CT angiogram (arrowhead), indicating the presence of hyperdense contrast material within the hematoma bed on postinjection CT; this has been associated with greater risk of subsequent hematoma expansion
80-year-old woman with numerous punctate foci of hypointensity (black dots) on MRI gradient-echo (GRE) sequence (left), suggesting multiple lobar microbleeds caused by cerebral amyloid angiopathy. MRI susceptibility-weighted imaging (SWI) sequence (right) demonstrates numerous additional microbleeds not seen on the GRE sequence

Citations

Key Articles

Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-361.[Abstract][Full Text]
Intercollegiate Stroke Working Party. The National clinical guideline for stroke for the United Kingdom and Ireland. Apr 2023 [internet publication].[Full Text]
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-e467.[Abstract][Full Text]
Steiner T, Al-Shahi Salman R, Beer R, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014 Oct;9(7):840-55.[Abstract][Full Text]

Other Online Resources

Massachusetts General Hospital Stroke Service: FUNC score calculator

Referenced Articles

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