What clinical findings help differentiate hemorrhagic stroke from ischemic stroke?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Although the definitive distinction of ischemic stroke from hemorrhagic stroke requires neuroimaging, a meta-analysis found that the following clinical findings increase the probability of hemorrhagic stroke [61] :

  • Coma (likelihood ratio [LR] 6.2)

  • Neck stiffness (LR 5.0)

  • Seizures accompanying the neurologic deficit (LR 4.7)

  • Diastolic blood pressure >110 mm Hg (LR 4.3)

  • Vomiting (LR 3.0)

  • Headache (LR 2.9)

Findings that decrease the probability of hemorrhage include cervical bruit (LR 0.12) and prior transient ischemic attack (LR 0.34).

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