Hemorrhagic stroke physical examination: Difference between revisions
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==Physical examination== | ==Physical examination== | ||
=== | Physical examination should include:<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="pmid11346811">{{cite journal| author=Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF| title=Spontaneous intracerebral hemorrhage. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 19 | pages= 1450-60 | pmid=11346811 | doi=10.1056/NEJM200105103441907 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11346811 }} </ref><ref name="pmid4105427">{{cite journal| author=Fisher CM| title=Pathological observations in hypertensive cerebral hemorrhage. | journal=J Neuropathol Exp Neurol | year= 1971 | volume= 30 | issue= 3 | pages= 536-50 | pmid=4105427 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4105427 }} </ref> | ||
*Vital signs | |||
*Level of consciousness ([[Glasgow Coma Scale|Glasgow Coma Scale (GCS)]]) | |||
*Level of severity of neurological deficit ([[National Institutes of Health Stroke Scale|National Institutes of Health Stroke Scale (NIHSS)]]) | |||
Physical examination of patients with Intracerebral hemorrhage is usually varies based on the location of the bleeding.<ref name="pmid4105427">{{cite journal| author=Fisher CM| title=Pathological observations in hypertensive cerebral hemorrhage. | journal=J Neuropathol Exp Neurol | year= 1971 | volume= 30 | issue= 3 | pages= 536-50 | pmid=4105427 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4105427 }} </ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center | ||
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! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Physical examination}} | ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Physical examination}} | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | ''' | | style="padding: 5px 5px; background: #DCDCDC;" | '''Putamenal hemorrhage''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Downward gaze | *[[Hemiplegia]] | ||
*[[Hemisensory loss]] | |||
*[[Homonymous hemianopsia]] | |||
*[[Gaze palsy]] | |||
*[[Stupor]] | |||
*[[Coma]] | |||
|- | |||
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | '''Thalamic hemorrhage''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |General signs: | |||
*Downward gaze (paralysis of upward gaze) | |||
*Small pupils (lack of light pupillary response) | *Small pupils (lack of light pupillary response) | ||
*Depressed consciousness | *Depressed consciousness | ||
| Line 42: | Line 39: | ||
*Impairment of verbal memory | *Impairment of verbal memory | ||
*Visuospatial dysfunction | *Visuospatial dysfunction | ||
|- style="background: #F5F5F5;" | |||
|Behavioural patterns based on the four main arterial thalamic territories: | |||
*Anterior: perservations, [[apathy]], and [[amnesia]] | |||
**Paramedian infarction: [[disinhibition]], personality change and [[amnesia]] (severe retrograde and [[anterograde amnesia]]) | |||
**Extensive lesions: "thalamic dementia" | |||
*Inferolateral: Executive dysfunction and occasionally severe long term disability | |||
*Posterior: No specific behavioural pattern however can include [[cognitive dysfunction]], [[neglect]], [[aphasia]] | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Pontine hemorrhage | | style="padding: 5px 5px; background: #DCDCDC;" | '''Pontine hemorrhage''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Decreased level of consciousness (most common) | *Decreased level of consciousness (most common) | ||
*Long tract signs including | *Long tract signs including [[tetraparesis]] | ||
*Cranial nerve palsies | *[[Cranial nerve palsies]] | ||
*Seizures | *[[Seizures]] | ||
*Cheyne-Stokes respiration | *[[Cheyne-Stokes respiration]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cerebellar hemorrhage | | style="padding: 5px 5px; background: #DCDCDC;" | '''Cerebellar hemorrhage''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Small bleeds | *Small bleeds | ||
**Ataxia | **[[Ataxia]] | ||
**Nystagmus | **[[Nystagmus]] | ||
*Larger bleeds | *Larger bleeds | ||
**Impair consciousness | **Impair consciousness | ||
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|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" |''' Lobar hemorrhage | | style="padding: 5px 5px; background: #DCDCDC;" |''' Lobar hemorrhage | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" |The signs vary depending on the location of the hemorrhage: | ||
*Acute neurological deterioration | *Acute neurological deterioration | ||
*Decreased GCS | *Decreased GCS | ||
*[[Seizure]] | |||
*Contralateral [[homonymous hemianopsia]] (occipital hemorrhage) | |||
*Contralateral plegia/[[paresis]] of the leg with relative sparing of the arm (frontal hemorrhage) | |||
|} | |} | ||
Latest revision as of 16:13, 30 November 2016
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Hemorrhagic stroke Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) |
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AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
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AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (2014) Sex-Specific Risk Factors
Risk Factors Commoner in Women |
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Case Studies |
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Hemorrhagic stroke physical examination On the Web |
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American Roentgen Ray Society Images of Hemorrhagic stroke physical examination |
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Risk calculators and risk factors for Hemorrhagic stroke physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical examination
Physical examination should include:[1][2][3][4]
- Vital signs
- Level of consciousness (Glasgow Coma Scale (GCS))
- Level of severity of neurological deficit (National Institutes of Health Stroke Scale (NIHSS))
Physical examination of patients with Intracerebral hemorrhage is usually varies based on the location of the bleeding.[4]
| Locations | Physical examination |
|---|---|
| Putamenal hemorrhage | |
| Thalamic hemorrhage | General signs:
|
Behavioural patterns based on the four main arterial thalamic territories:
| |
| Pontine hemorrhage |
|
| Cerebellar hemorrhage |
|
| Lobar hemorrhage | The signs vary depending on the location of the hemorrhage:
|
References
- ↑ 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.
- ↑ 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
- ↑ Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001). "Spontaneous intracerebral hemorrhage". N Engl J Med. 344 (19): 1450–60. doi:10.1056/NEJM200105103441907. PMID 11346811.
- ↑ 4.0 4.1 Fisher CM (1971). "Pathological observations in hypertensive cerebral hemorrhage". J Neuropathol Exp Neurol. 30 (3): 536–50. PMID 4105427.