Hemorrhagic stroke emergency diagnosis and assessment

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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) Management of ICH
AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) Management of aSAH
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Intracerebral hemorrhage is a medical emergency, characterized by high morbidity and mortality, which should be promptly diagnosed and aggressively managed. Hematoma expansion and early deterioration are common within the first few hours after onset. CT and magnetic resonance imaging (MRI) are both reasonable for initial evaluation.

Emergency diagnosis and assessment

Intracerebral hemorrhage is a medical emergency, characterized by high morbidity and mortality, which should be promptly diagnosed and aggressively managed. Hematoma expansion and early deterioration are common within the first few hours after onset.

2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Emergency Diagnosis and Assessment: Recommendations

Class I

"1.A baseline severity score should be performed as part of the initial evaluation of patients with intracerebral hemorrhage (ICH) (Level of Evidence: B)"

"2.Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from intracerebral hemorrhage (ICH) (Level of Evidence: A)"

Class IIa

"1.CT angiography, CT venography, contrast-enhanced CT, contrast-enhanced MRI, MRA and MRV can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiologic suspicion (Level of Evidence: B)"

Class IIb

"1.CT angiography and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Level of Evidence: B)"

References

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