eMedicine Specialties > Emergency Medicine > Neurology

Stroke, Hemorrhagic: Differential Diagnoses & Workup

Author: Denise Nassisi, MD, Assistant Professor, Department of Emergency Medicine, Mount Sinai Medical Center
Contributor Information and Disclosures

Updated: Feb 5, 2008

Differential Diagnoses

Encephalitis
Meningitis
Headache, Migraine
Neoplasms, Brain
Hypernatremia
Stroke, Ischemic
Hyperosmolar Hyperglycemic Nonketotic Coma
Subarachnoid Hemorrhage
Hypertensive Emergencies
Subdural Hematoma
Hypoglycemia
Transient Ischemic Attack
Hyponatremia
Labyrinthitis

Other Problems to Be Considered

Postictal (Todd) paralysis
Hyperosmolality

Workup

Laboratory Studies

  • Complete blood count
  • Coagulation profile
  • Electrolytes
  • Serum glucose
  • Blood type and screen

Imaging Studies

  • Brain imaging
    • Brain imaging is a crucial step in a patient's evaluation.
    • It must be obtained on an emergent basis.
    • Brain imaging aids in making the diagnosis of hemorrhage.
    • It may identify complications including intraventricular hemorrhage, brain edema, or hydrocephalus.
    • Either noncontrast CT or MRI of the brain are the modalities of choice.
    • Noncontrast CT of the brain
      • Noncontrast CT differentiates hemorrhagic stroke from ischemic stroke.
      • It is useful in distinguishing stroke from other intracranial pathology.
      • It can identify virtually all intracerebral hematomas greater than 1 cm in diameter.
    • MRI
      • In the past, noncontrast CT was the criterion standard for diagnosing hemorrhagic stroke. Recent progress has demonstrated that current MRI techniques are capable of accurately diagnosing hemorrhagic stroke.
      • MRI, especially newer techniques such as diffusion-weighted imaging, has been shown to identify ischemic stroke earlier and more reliably than CT scanning. MRI is being used with increasing frequency in the evaluation of ischemic stroke.
      • MRI may identify an underlying vascular malformation or lesion that caused the bleeding.
  • Head CT should be obtained in patients with contraindications to MRI.
  • Chest radiography should be obtained to screen for comorbid conditions.

Other Tests

  • Obtain an electrocardiogram (ECG) and begin cardiac monitoring. Cardiac dysrhythmias and myocardial ischemia have a significant coincidence with stroke.

More on Stroke, Hemorrhagic

Overview: Stroke, Hemorrhagic
Differential Diagnoses & Workup: Stroke, Hemorrhagic
Treatment & Medication: Stroke, Hemorrhagic
Follow-up: Stroke, Hemorrhagic
Multimedia: Stroke, Hemorrhagic
References
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References

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Further Reading

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Keywords

intracerebral hemorrhage, ICH, intracerebral bleeds, hypertension, neurologic function, cerebrovascular accident, CVA, stroke syndrome, thrombosis, embolism, hemorrhage, hemorrhagic stroke, cerebrovascular disease, neurologic complications, antithrombotic therapy, thrombolytic therapy, focal neurologic deficits, bleeding diatheses, iatrogenic anticoagulation, coagulopathies, anticoagulant therapy, iatrogenic hemorrhagic stroke, cerebral amyloidosis, cocaine abuse, mass effect of hematoma, hemiparesis, quadriparesis, hemisensory loss, aphasia, hemi-inattention, brainstem compression, brainstem herniation, apnea, limb ataxia, diplopia, nystagmus, oropharyngeal weakness, dysphagia, crossed signs, new-onset seizure, stroke, stroke management

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Contributor Information and Disclosures

Author

Denise Nassisi, MD, Assistant Professor, Department of Emergency Medicine, Mount Sinai Medical Center
Denise Nassisi, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Heart Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard S Krause, MD, Senior Faculty, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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