Ischemic Stroke vs Hemorrhagic (Intracerebral) Stroke
Ischemic Stroke and Hemorrhagic (Intracerebral) Stroke are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Ischemic Stroke vs Hemorrhagic (Intracerebral) Stroke at a glance
- Ischemic Stroke: Acute focal neurologic deficit from arterial occlusion causing brain infarction.
- Hemorrhagic (Intracerebral) Stroke: Non-traumatic bleeding into brain parenchyma; higher mortality than ischemic stroke.
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Side-by-side comparison
| Feature | Ischemic Stroke | Hemorrhagic (Intracerebral) Stroke |
|---|---|---|
| At a glance | Acute focal neurologic deficit from arterial occlusion causing brain infarction. | Non-traumatic bleeding into brain parenchyma; higher mortality than ischemic stroke. |
| Classic presentation | Sudden onset focal deficit referable to a single vascular territory; NIHSS quantifies severity (0-42).; Sudden, focal neurologic deficit: unilateral weakness,… | Hypertensive ICH classically in basal ganglia (putamen most common), thalamus, pons, or cerebellum. ICH score predicts 30-day mortality.; Sudden focal… |
| Workup / key labs | Clinical syndrome of acute focal neurologic deficit with imaging evidence of infarction (CT hypodensity or MRI DWI restriction) and exclusion of hemorrhage.;… | CBC, platelets, PT/INR, PTT — assess coagulopathy; BMP, glucose, troponin; Toxicology screen (cocaine, methamphetamine in young patients); Type and screen |
| Imaging | Non-contrast head CT within 20 min of arrival — excludes hemorrhage (essential before tPA); CT angiography head and neck — identifies large vessel occlusion… | Non-contrast head CT — high-density acute hematoma; immediately diagnostic; CT angiography — 'spot sign' (contrast extravasation) predicts hematoma expansion;… |
| First-line treatment | tPA dosing — alteplase 0.9 mg/kg IV (max 90 mg), 10% as bolus over 1 min, remainder over 60 min, if within 4.5 h of last known well and no contraindications… | ABCs, intubation if GCS ≤8 or aspiration risk; BP control: target SBP 130-150 within first hour (INTERACT2, ATACH-2). Agents: IV nicardipine, clevidipine,… |
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