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, sensory loss, aphasia, dysarthria, gaze deviation, hemianopia, ataxia, vertigo; Symptoms maximal at onset (contrast with progressive course of tumor); Headache uncommon (more… | Hypertensive ICH classically in basal ganglia (putamen most common), thalamus, pons, or cerebellum. ICH score predicts 30-day mortality.; Sudden focal neurologic deficit (similar to ischemic stroke); Headache (more common and severe than ischemic stroke); Nausea/vomiting; Decreased level of consciousness, often progressive over… |
| 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.; Fingerstick glucose immediately (rule out hypoglycemia); CBC, platelets, PT/INR, PTT, BMP, troponin; Lipid panel, A1c — for secondary prevention; Pregnancy test in women of… | 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 candidates for thrombectomy; CT perfusion or MR diffusion/perfusion — quantifies core vs penumbra for extended-window thrombectomy (DAWN, DEFUSE-3); MRI with DWI — most sensitive… | Non-contrast head CT — high-density acute hematoma; immediately diagnostic; CT angiography — 'spot sign' (contrast extravasation) predicts hematoma expansion; rules out underlying vascular lesion; MRI with susceptibility-weighted imaging — chronic microbleeds suggest cerebral amyloid angiopathy or hypertensive disease; Catheter… |
| 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 (NINDS, ECASS III); Tenecteplase 0.25 mg/kg IV bolus — increasingly used alternative, particularly with LVO bridging to thrombectomy; Mechanical thrombectomy for anterior… | ABCs, intubation if GCS ≤8 or aspiration risk; BP control: target SBP 130-150 within first hour (INTERACT2, ATACH-2). Agents: IV nicardipine, clevidipine, labetalol; Reverse anticoagulation immediately: warfarin → 4-factor PCC + vitamin K 10 mg IV; dabigatran → idarucizumab 5 g IV; factor Xa inhibitors → andexanet alfa or 4-factor PCC;… |
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