Hemorrhagic stroke laboratory findings: Difference between revisions

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==Overview==
==Overview==
Routine laboratory studies in patient with intracerebral hemorrhage should include [[Complete blood count|complete blood count (CBC)]] with [[platelets]], [[electrolytes]], [[renal function]], coagulation studies ([[Prothrombin time|prothrombin time (PT)]], [[Partial thromboplastin time|partial thromboplastin time (PTT)]], and [[INR]]), [[toxicology screen]], blood glucose level, and [[pregnancy test]] in women of childbearing age.<ref name="pmid17478736">{{cite journal| author=Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D et al.| title=Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. | journal=Stroke | year= 2007 | volume= 38 | issue= 6 | pages= 2001-23 | pmid=17478736 | doi=10.1161/STROKEAHA.107.183689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17478736  }} </ref><ref name="pmid17962600">{{cite journal| author=Bos MJ, Koudstaal PJ, Hofman A, Breteler MM| title=Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study. | journal=Stroke | year= 2007 | volume= 38 | issue= 12 | pages= 3127-32 | pmid=17962600 | doi=10.1161/STROKEAHA.107.489807 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17962600  }}</ref><ref name="pmid23077009">{{cite journal| author=Hackam DG, Mrkobrada M| title=Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. | journal=Neurology | year= 2012 | volume= 79 | issue= 18 | pages= 1862-5 | pmid=23077009 | doi=10.1212/WNL.0b013e318271f848 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23077009  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23449782 Review in: Evid Based Ment Health. 2013 May;16(2):54]</ref><ref name="pmid18703803">{{cite journal| author=Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P, CHANT Investigators| title=Hematoma growth in oral anticoagulant related intracerebral hemorrhage. | journal=Stroke | year= 2008 | volume= 39 | issue= 11 | pages= 2993-6 | pmid=18703803 | doi=10.1161/STROKEAHA.108.520668 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703803  }}</ref><ref name="pmid17356187">{{cite journal| author=Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M| title=Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios. | journal=Neurocrit Care | year= 2007 | volume= 6 | issue= 1 | pages= 22-9 | pmid=17356187 | doi=10.1385/NCC:6:1:22 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17356187  }}</ref>


==Laboratory findings==
==Laboratory findings==
Laboratory findings for intracerebral hemorrhage may include the following:<ref name="pmid17478736">{{cite journal| author=Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D et al.| title=Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. | journal=Stroke | year= 2007 | volume= 38 | issue= 6 | pages= 2001-23 | pmid=17478736 | doi=10.1161/STROKEAHA.107.183689 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17478736  }} </ref>
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{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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|+  
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*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
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| style="padding: 5px 5px; background: #F5F5F5;" |
*Monitor for infection  
*Monitor for [[infection]]
*Assess hematocrit and platelet count to identify hemorrhagic risk and complications
*Assess [[hematocrit]] and [[platelet count]] to identify hemorrhagic risk and complications
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Lipid profile|'''Lipid profile''']]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Basic metabolic panel|'''BMP''']]/[[Osmolarity|'''Osmolarity''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased [[LDL]], [[triglycerides]] and [[cholesterol]]
*Increased or decreased serum NA2+, K+, Ca2+
*Change in osmolarity 
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May increase the risk of thromboembolic event<ref name="pmid19901173">{{cite journal| author=Willey JZ, Xu Q, Boden-Albala B, Paik MC, Moon YP, Sacco RL et al.| title=Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS). | journal=Arch Neurol | year= 2009 | volume= 66 | issue= 11 | pages= 1400-6 | pmid=19901173 | doi=10.1001/archneurol.2009.210 | pmc=2830863 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19901173  }} </ref><ref name="pmid24250834">{{cite journal| author=Togha M, Gheini MR, Ahmadi B, Khashaiar P, Razeghi S| title=Lipid profile in cerebrovascular accidents. | journal=Iran J Neurol | year= 2011 | volume= 10 | issue= 1-2 | pages= 1-4 | pmid=24250834 | doi= | pmc=3829214 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24250834  }} </ref><ref name="pmid24696996">{{cite journal| author=Lisak M, Demarin V, Trkanjec Z, Basić-Kes V| title=Hypertriglyceridemia as a possible independent risk factor for stroke. | journal=Acta Clin Croat | year= 2013 | volume= 52 | issue= 4 | pages= 458-63 | pmid=24696996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24696996  }} </ref>
*Monitor osmolarity for guidance of [[osmotic diuresis]]
|-
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| style="padding: 5px 5px; background: #F5F5F5;" |[[PT|'''PT''']]'''/[[APTT]]/[[INR]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[PT|'''PT''']]'''/[[APTT]]/[[INR]]'''
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*Increased BUN and creatinine
*Increased BUN and creatinine
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Mild to moderate renal dysfunction is an independant risk factor for ischemic stroke<ref name="pmid16864812">{{cite journal| author=Koren-Morag N, Goldbourt U, Tanne D| title=Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease. | journal=Neurology | year= 2006 | volume= 67 | issue= 2 | pages= 224-8 | pmid=16864812 | doi=10.1212/01.wnl.0000229099.62706.a3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16864812  }} </ref><ref name="pmid25526464">{{cite journal| author=Hao Z, Yang C, Liu M, Wu B| title=Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 28 | pages= e286 | pmid=25526464 | doi=10.1097/MD.0000000000000286 | pmc=4603096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25526464  }} </ref>
*
*May be associated with poor prognosis in patients with ischemic stroke<ref name="pmid25526464">{{cite journal| author=Hao Z, Yang C, Liu M, Wu B| title=Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 28 | pages= e286 | pmid=25526464 | doi=10.1097/MD.0000000000000286 | pmc=4603096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25526464  }} </ref><ref name="pmid25091540">{{cite journal| author=Laible M, Horstmann S, Rizos T, Rauch G, Zorn M, Veltkamp R| title=Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation. | journal=Eur J Neurol | year= 2015 | volume= 22 | issue= 1 | pages= 64-9, e4-5 | pmid=25091540 | doi=10.1111/ene.12528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25091540  }} </ref>
*May be associated with poor prognosis in patients with intracerebral hemorrhage and hematoma expansion
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |'''Serum [[Homocysteine|homocysteine]] level'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Toxicology screen|'''Toxicology screen''']]'''/Serum alcohol level'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased levels of serum homocysteine levels
*Increased levels of serum
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May be associated with increased risk of thromboembolic event<ref name="pmid27629768">{{cite journal| author=Yao ES, Tang Y, Xie MJ, Wang MH, Wang H, Luo X| title=Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke. | journal=Med Sci Monit | year= 2016 | volume= 22 | issue=  | pages= 3268-73 | pmid=27629768 | doi= | pmc=5034885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27629768  }} </ref><ref name="pmid24174694">{{cite journal| author=Ashjazadeh N, Fathi M, Shariat A| title=Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes. | journal=Iran J Med Sci | year= 2013 | volume= 38 | issue= 3 | pages= 233-9 | pmid=24174694 | doi= | pmc=3808947 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24174694  }} </ref>
*Identify illicit drug use or excessive alcohol
*Identify exogenous toxins that can cause [[intracerebral hemorrhage]] (ICH)
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Basic metabolic panel|'''Basic metabolic panel''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased or decreased serum NA2+, K+, Ca2+
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May mimic or complicate patients with ischemic stroke<ref name="pmid23134903">{{cite journal| author=Alam MN, Uddin MJ, Rahman KM, Ahmed S, Akhter M, Nahar N et al.| title=Electrolyte changes in stroke. | journal=Mymensingh Med J | year= 2012 | volume= 21 | issue= 4 | pages= 594-9 | pmid=23134903 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23134903  }} </ref><ref name="pmid21510233">{{cite journal| author=Guven H, Cilliler AE, Koker C, Sarikaya SA, Comoglu SS| title=Association of serum calcium levels with clinical severity of acute ischemic stroke. | journal=Acta Neurol Belg | year= 2011 | volume= 111 | issue= 1 | pages= 45-9 | pmid=21510233 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21510233  }} </ref><ref name="pmid23966823">{{cite journal| author=Farahmand F, Choobi Anzali B, Heshmat R, Ghafouri HB, Hamedanchi S| title=Serum Sodium and Potassium Levels in Cerebro-vascular Accident Patients. | journal=Malays J Med Sci | year= 2013 | volume= 20 | issue= 3 | pages= 39-43 | pmid=23966823 | doi= | pmc=3743980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23966823  }} </ref>
*
| style="padding: 5px 5px; background: #F5F5F5;" |
*
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[HbA1C|'''HbA1C''']]
| style="padding: 5px 5px; background: #F5F5F5;" |[[HbA1C|'''HbA1C''']]
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*Increased levels of HbA1c  
*Increased levels of HbA1c  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*May suggest control of diabetes in past few months
*
*Increased levels associated with increased risk of ischemic stroke<ref name="pmid22111048">{{cite journal| author=Oh HG, Rhee EJ, Kim TW, Lee KB, Park JH, Yang KI et al.| title=Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic korean male adults. | journal=Diabetes Metab J | year= 2011 | volume= 35 | issue= 5 | pages= 551-7 | pmid=22111048 | doi=10.4093/dmj.2011.35.5.551 | pmc=3221032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22111048  }} </ref>
*May be associated with poor prognosis in patients with ischemic stroke
|-  
|-  
| style="padding: 5px 5px; background: #F5F5F5;" |'''Blood glucose levels'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Blood glucose levels'''<ref name="pmid9249937">{{cite journal| author=Sawyer GJ, Fabre JW| title=Indirect T-cell allorecognition and the mechanisms of immunosuppression by allogeneic blood transfusions. | journal=Transpl Int | year= 1997 | volume= 10 | issue= 4 | pages= 276-83 | pmid=9249937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9249937  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Increased or decreased levels of blood glucose
*Increased or decreased levels of blood glucose
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Hyperglycemia]] is associated with poor prognosis of ischemic stroke<ref name="pmid11493160">{{cite journal| author=Kagansky N, Levy S, Knobler H| title=The role of hyperglycemia in acute stroke. | journal=Arch Neurol | year= 2001 | volume= 58 | issue= 8 | pages= 1209-12 | pmid=11493160 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11493160  }} </ref><ref name="pmid20848328">{{cite journal| author=Bruno A, Liebeskind D, Hao Q, Raychev R, UCLA Stroke Investigators| title=Diabetes mellitus, acute hyperglycemia, and ischemic stroke. | journal=Curr Treat Options Neurol | year= 2010 | volume= 12 | issue= 6 | pages= 492-503 | pmid=20848328 | doi=10.1007/s11940-010-0093-6 | pmc=2943579 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20848328  }} </ref><ref name="pmid21861124">{{cite journal| author=Baker L, Juneja R, Bruno A| title=Management of hyperglycemia in acute ischemic stroke. | journal=Curr Treat Options Neurol | year= 2011 | volume= 13 | issue= 6 | pages= 616-28 | pmid=21861124 | doi=10.1007/s11940-011-0143-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21861124  }} </ref><ref name="pmid17099262">{{cite journal| author=Gilmore RM, Stead LG| title=The role of hyperglycemia in acute ischemic stroke. | journal=Neurocrit Care | year= 2006 | volume= 5 | issue= 2 | pages= 153-8 | pmid=17099262 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17099262  }} </ref>
*May be associated with poor prognosis in patients with [[Intracerebral hemorrhage]]
*Hypoglycemia may complicate or mimic patients with ischemic stroke<ref name="pmid21211743">{{cite journal| author=Radermecker RP, Scheen AJ| title=Management of blood glucose in patients with stroke. | journal=Diabetes Metab | year= 2010 | volume= 36 Suppl 3 | issue=  | pages= S94-9 | pmid=21211743 | doi=10.1016/S1262-3636(10)70474-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21211743  }} </ref>
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac enzymes|'''Cardiac enzymes''']]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Cardiac enzymes|'''Cardiac enzymes''']]
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*Serum and urine B-HCG
*Serum and urine B-HCG
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rule out pregnancy in all female patients with ischemic stroke since t-PA is a class C agent<ref name="pmid23632643">{{cite journal| author=Grear KE, Bushnell CD| title=Stroke and pregnancy: clinical presentation, evaluation, treatment, and epidemiology. | journal=Clin Obstet Gynecol | year= 2013 | volume= 56 | issue= 2 | pages= 350-9 | pmid=23632643 | doi=10.1097/GRF.0b013e31828f25fa | pmc=3671374 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23632643  }} </ref>
*Rule out pregnancy in all female patients with hemorrhagic stroke
|-
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|}
|}


==References==
==References==

Latest revision as of 16:29, 30 November 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Routine laboratory studies in patient with intracerebral hemorrhage should include complete blood count (CBC) with platelets, electrolytes, renal function, coagulation studies (prothrombin time (PT), partial thromboplastin time (PTT), and INR), toxicology screen, blood glucose level, and pregnancy test in women of childbearing age.[1][2][3][4][5]

Laboratory findings

Laboratory findings for intracerebral hemorrhage may include the following:[1]

Blood test Test result Rationale
Complete blood count and platelet
BMP/Osmolarity
  • Increased or decreased serum NA2+, K+, Ca2+
  • Change in osmolarity
PT/APTT/INR
  • Increased PT/APTT/INR
BUN/Creatinine
  • Increased BUN and creatinine
  • May be associated with poor prognosis in patients with intracerebral hemorrhage and hematoma expansion
Toxicology screen/Serum alcohol level
  • Increased levels of serum
HbA1C
  • Increased levels of HbA1c
Blood glucose levels[6]
  • Increased or decreased levels of blood glucose
Cardiac enzymes
  • Increased serum levels of Trop I, Trop T, CK-MB
  • Elevated Trop T levels are associated with poor prognosis
  • May suggest ongoing myocardial ischemia[7]
Pregnancy test
  • Serum and urine B-HCG
  • Rule out pregnancy in all female patients with hemorrhagic stroke

References

  1. ↑ 1.0 1.1 Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D; et al. (2007). "Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group". Stroke. 38 (6): 2001–23. doi:10.1161/STROKEAHA.107.183689. PMID 17478736.
  2. ↑ 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.
  3. ↑ 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
  4. ↑ Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P, CHANT Investigators (2008). "Hematoma growth in oral anticoagulant related intracerebral hemorrhage". Stroke. 39 (11): 2993–6. doi:10.1161/STROKEAHA.108.520668. PMID 18703803.
  5. ↑ Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M (2007). "Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios". Neurocrit Care. 6 (1): 22–9. doi:10.1385/NCC:6:1:22. PMID 17356187.
  6. ↑ Sawyer GJ, Fabre JW (1997). "Indirect T-cell allorecognition and the mechanisms of immunosuppression by allogeneic blood transfusions". Transpl Int. 10 (4): 276–83. PMID 9249937.
  7. ↑ Norris JW, Hachinski VC, Myers MG, Callow J, Wong T, Moore RW (1979). "Serum cardiac enzymes in stroke". Stroke. 10 (5): 548–53. PMID 505497.


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