Hemorrhagic stroke natural history
Hemorrhagic stroke Microchapters |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) |
AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (2014) Sex-Specific Risk Factors
Risk Factors Commoner in Women |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural history
In Inracerebral hemorrhage|Inracerebral hemorrhage (ICH), underlying small vessel disease may result in acute vessel rupture. This acute vessel rupture can progress can result in brain injury by folllowing mechanisms:
- The mass effect from the hematoma itself
- Activation of the coagulation cascade and release of inflammatory cytokines, and blood-brain barrier (BBB) disruption
All of these mechnisems can lead to perihematomal edema formation and secondary brain injury. Aditionally, continued bleeding, or hematoma expansion, occurs in many patients—either continued bleeding from the primary source or secondary bleeding at the periphery of the hemorrhage
Based on the anatomic location and size of the hemorrhage, hemorrhagic stroke may have a different outcome
- Large clot may form and compress adjacent tissue, and may result in herniation and death.
- Blood may also dissect into the ventricular space, which substantially increases morbidity and may cause hydrocephalus
Baseline NIHSS and Glasgow Coma Scale (GCS) scores can be used to assess stroke severity, although the GCS score may be more feasible to follow for neurologic deterioration ( Box 101-3 ). In addition, serial examinations can detect early changes that may suggest ongoing bleeding during the acute phase.
(NIH) Stroke Scale Scoring
National Institutes of Health Stroke Scale
The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.[1] The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0.[2][3]
Score[3] | Stroke severity |
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0 |
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1-4 |
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5-15 |
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16-20 |
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21-42 |
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The National Institutes of Health Stroke Scale has been repeatedly validated as a tool for assessing stroke severity and as an excellent predictor for patient outcomes.[4][5][6] Severity of a stroke is heavily correlated with the volume of brain affected by the stroke, strokes effecting larger portions of the brain tend to have more detrimental effects.[7] NIHSS scores have been found to be reliable predictors of damaged brain volume, with a smaller NIHSS score indicating a smaller lesion volume[8]
Item | Scoring Definitions |
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Level of consciousness (LOC) Responsiveness |
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LOC Questions (patient's age and month) |
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LOC Commands (open/close eyes and then grip/release hand) |
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Horizontal Eye Movement (voluntary or doll's eye maneuver) |
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Visual field (each eye is tested individually) |
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Facial palsy (in stuporous, check symmetry of grimace to pain) |
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Motor arm (arms outstretched for 10 seconds) |
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Motor leg (raise leg for 5 seconds) |
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Limb ataxia (check finger-nose-finger, heel-shin position sense/score only if out of proportion to paralysis) |
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Sensory (check grimace or withdrawal if patient is stuporous) |
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Best language (describe the scenario in the figure, name objects, read sentences) |
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Dysarthria (read list of words) |
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Extinction or neglect (simultaneously touch patient on both hands/show fingers in both visual fields) |
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Prognosis
- Despite aggressive and newer management strategies, the prognosis of patients with intracerebral hemorrhage is very poor.
- Case-fatality at 1 month is over 40 % and has not improved in last few decades.[9]
References
- ↑ National Institute of Health, National Institute of Neurological Disorders and Stroke. Stroke Scale. http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf.
- ↑ NIH Stroke Scale Training,Part 2. Basic Instruction. Department of Health and Human Services, National Institute of Neurological Disorders and Stroke. The National Institute of Neurological Disorders and Stroke (NINDS) Version 2.0
- ↑ 3.0 3.1 Ver Hage ,. The NIH stroke scale: a window into neurological status. Nurse.Com Nursing Spectrum (Greater Chicago) [serial online]. September 12, 2011;24(15):44-49.
- ↑ Muir KW, Weir CJ, Murray GD, Povey C, Lees KR (1996). "Comparison of neurological scales and scoring systems for acute stroke prognosis". Stroke. 27: 1817–1820. doi:10.1161/01.str.27.10.1817.
- ↑ Frankel MR, Morgenstern LB, Kwiatkowski T, Lu M, Tilley BC, Broderick JP, Libman R, Levine SR, Brott T (2000). "Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial". Neurology. 55: 952–959. doi:10.1212/wnl.55.7.952.
- ↑ Dehaan R, Horn J, Limburg M, et al: A comparison of 5 stroke scales with measures of disability, handicap, and quality-of-life. Stroke 1993;24:1178–81
- ↑ Weimar C, Konig I, Kraywinkel K, Ziegler A, Diener H. "Age and national institutes of health stroke scale score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia - Development and external validation of prognostic models". Stroke. 35 (1): 158–162. doi:10.1161/01.str.0000106761.94985.8b.
- ↑ Glymour M, Berkman L, Ertel K, Fay M, Glass T, Furie K (2007). "Lesion characteristics, NIH Stroke Scale, and functional recovery after stroke". American Journal of Physical Medicine & Rehabilitation. 86 (9): 725–733. doi:10.1097/phm.0b013e31813e0a32.
- ↑ Apanasenko BG, Kunitsyn AI, Isaev GA, Khodyrev LP (1976). "[Determination of the weight of disemulsified lipid circulating in the blood as a method of diagnosis of fat embolism]". Lab Delo (1): 41–3. PMID 0056489.