Principles of Clinical Diagnosis of Hemorrhagic Stroke

  • Max WintermarkEmail author
  • Tanvir Rizvi
Part of the Stroke Revisited book series (STROREV)


Hemorrhagic stroke comprises approximately 10–15% of all strokes. Rapid and accurate diagnosis of hemorrhagic stroke is essential for clinical management of such patients. Hypertension-related deep perforating vasculopathy and cerebral amyloid angiopathy are the two most frequent primary causes of intracranial hemorrhage (ICH). The less common secondary causes include hemorrhagic infarction, arteriovenous malformation (AVM)- or dural arteriovenous fistula (dAVF)-related hemorrhage, cavernous malformations, neoplasm related, coagulopathy/bleeding dyscrasias including iatrogenic supratherapeutic anticoagulation, thrombolytic therapy, venous sinus thrombosis, septic emboli associated, CNS infections like herpes, mycotic aneurysm, vasculitis, moyamoya disease, and vasoactive drugs. Clinical diagnosis of hemorrhagic stroke besides history and physical examination necessitates routine blood tests including most importantly coagulation parameters. Neuroimaging plays a key role in diagnosis, treatment, and prognostication of patients with ICH. Non-contrast CT is the initial investigation modality with MRI including blood-sensitive T2* and susceptibility-weighted imaging (SWI), diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery sequence (FLAIR), and post-contrast T1W sequences providing additional information to narrow down the differential diagnosis. Vascular imaging is performed by CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA), which provides additional information about vascular status including ruptured aneurysms, vasculitis, and venous sinus thrombosis. Transcranial Doppler is a noninvasive effective diagnostic tool to detect and monitor vasospasm in patients with subarachnoid hemorrhage due to ruptured aneurysms in critical care settings.


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Copyright information

© Springer Science+Business Media Singapore 2018

Authors and Affiliations

  1. 1.Neuroradiology Division, Department of RadiologyStanford UniversityStanfordUSA
  2. 2.Neuroradiology Division, Department of RadiologyUniversity of Mississippi Medical CenterJacksonUSA

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