April 13, 2021; 96 (15) Editorial Show
First published March 5, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011738  This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased. Distinguishing ischemic from hemorrhagic stroke has important implications for acute treatment. Thrombolytic therapy is of benefit for patients with ischemic infarctions but is contraindicated in intracranial hemorrhage.1 Brain imaging is the workhorse to differentiate ischemic from hemorrhagic stroke because clinical symptoms are nonspecific. A plasma-based biomarker to aid in the distinction of these 2 stroke subtypes has long been sought, but to date, sufficient sensitivity or specificity for clinical use has not been achieved.2 Footnotes
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All VideosStrokes can be classified into 2 main categories: Ischemic strokes. These are strokes caused by blockage of an artery (or, in rare instances, a vein). About 87% of all strokes are ischemic. Hemorrhagic stroke.
These are strokes caused by bleeding. About 13% of all strokes are hemorrhagic. What is an ischemic stroke?An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients. Ischemic strokes are further divided into 2 groups:
Thrombotic strokeThrombotic strokes are strokes caused by a thrombus (blood clot) that develops in the arteries supplying blood to the brain. This type of stroke is usually seen in older persons, especially those with high cholesterol and atherosclerosis (a buildup of fat and lipids inside the walls of blood vessels) or diabetes. Sometimes, symptoms of a thrombotic stroke can occur suddenly and often during sleep or in the early morning. At other times, it may occur gradually over a period of hours or even days. Thrombotic strokes may be preceded by one or more "mini-strokes," called transient ischemic attacks, or TIAs. TIAs may last for a few minutes or up to 24 hours, and are often a warning sign that a stroke may occur. Although usually mild and transient, the symptoms caused by a TIA are similar to those caused by a stroke. Another type of stroke that occurs in the small blood vessels in the brain is called a lacunar infarct. The word lacunar comes from the Latin word meaning "hole" or "cavity." Lacunar infarctions are often found in people who have diabetes or high blood pressure. Embolic strokeEmbolic strokes are usually caused by a blood clot that forms elsewhere in the body (embolus) and travels through the bloodstream to the brain. Embolic strokes often result from heart disease or heart surgery and occur rapidly and without any warning signs. About 15% of embolic strokes occur in people with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers of the heart do not beat effectively. Surviving Stroke at a Young Age | Sam’s Story
What is a hemorrhagic stroke?Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not get oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur, which can lead to further brain damage. Hemorrhagic strokes are divided into 2 main categories, including the following:
Intracerebral hemorrhageIntracerebral hemorrhage is usually caused by high blood pressure. Bleeding occurs suddenly and rapidly. There are usually no warning signs and bleeding can be severe enough to cause coma or death. Subarachnoid hemorrhageSubarachnoid hemorrhage results when bleeding occurs between the brain and the membrane that covers the brain (meninges) in the subarachnoid space. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation (AVM). It can also be caused by trauma.
What are recurrent strokes?Recurrent strokes occur in about 1 in 4 people who have had a stroke within 5 years after a first stroke. The risk is greatest right after a stroke and decreases over time. The likelihood of severe disability and death increases with each recurrent stroke. About 3% of people who have had a stroke have a second stroke within 30 days of their first stroke, and about one-third have a second stroke within 2 years.
Treatment Rehabilitation After a Stroke: Mary’s StoryAt 88 years old, Mary is an avid Scrabble player and church choir singer. She knows her way around the iPad. And even after her stroke, she wasn’t about to give up her favorite things in life. Related
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What is the differential diagnosis between ischemic and hemorrhagic stroke?Stroke can be either ischemic or hemorrhagic. Ischemic stroke is due to the loss of blood supply to an area of the brain. It is a common type of stroke. Hemorrhagic stroke is due to bleeding into the brain by the rupture of a blood vessel.
Why are hemorrhagic strokes worse than ischemic?Those who suffer ischemic strokes have a much better chance for survival than those who experience hemorrhagic strokes, as hemorrhagic stroke not only damages brain cells but also may lead to increased pressure on the brain or spasms in the blood vessels [9].
Which of the following statements correctly differentiates between ischemic and hemorrhagic stroke?An ischemic stroke is when blood vessels to the brain become clogged. A hemorrhagic stroke is when bleeding interferes with the brain's ability to function.
What is considered the best method to differentiate between hemorrhage and infarct?At present, one of the most accurate methods of distinguishing cerebral hemorrhage from infarction is CT. Although CT is very sensitive in the detection of intracerebral hemorrhage, it can be inconclusive in early stages of cerebral ischemic infarction.
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Why is it important to differentiate between hemorrhagic and ischemic stroke
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