Intracranial Hemorrhage Complicating Acute Stroke: How Common Is Hemorrhagic Stroke on Initial Head CT Scan and How Often Is Initial Clinical Diagnosis of Acute Stroke Eventually Confirmed?

Article Figures & Data

TABLE 1:

Primary neurologic discharge diagnoses with incidence in group of 691 consecutive patients with admitting diagnosis of clinical acute stroke

Primary Neurologic Discharge Diagnosis	Patients
Stroke	495
Multisystem organ disorder/failure	36
Intracranial hemorrhage	25
Lacunar stroke	24
Brain tumor	9
Weakness (not otherwise specified)	8
Cerebrovascular disease	8
Vertigo (idiopathic)	5
Vertebrobasilar syndrome	5
Gait disorder (not otherwise specified)	5
Encephalitis	5
Syncope (idiopathic)	4
Migraine	4
Labyrinthitis	4
Ataxia (idiopathic)	4
Psychiatric disturbance (DSM IV axis I)	3
Multiple sclerosis and/or optic neuritis	3
Head trauma (closed head injury)	3
Dehydration	3
Bell’s palsy	3
Pneumonia	2
Peripheral neuropathy	2
Numbness (not otherwise specified)	2
Hypoglycemia	2
Dizziness (idiopathic)	2
Delirium	2
Confusion (not otherwise specified)	2
Atypical angina	2
Sepsis	1
Seizure	1
Speech abnormality (not otherwise specified)	1
Degenerative disease of the spine	1
Polyneuropathy	1
Overdose	1
Multi-infarct dementia	1
Myoclonus (not otherwise specified)	1
Meningitis	1
Lyme disease	1
Hydrocephalus	1
Congestive heart failure	1
Headache (idiopathic)	1
Gastrointestinal bleed	1
Failure to thrive	1
Dysequilibrium (idiopathic)	1
Cerebral infarction with transient symptoms	1
Cholecystitis	1
Amnesia	1
Total	691

TABLE 2:

Results from 691 consecutive patients with acute stroke and intracranial hemorrhage on initial computed tomography scan

Patient No./Sex/Age (y)	Time (h:min)^*	Type	Embolic	Character and Etiology of Infarct^†
1/F/21	1:40	IPH	Yes	HI
2/M/49	1:16	IPH	No	Hypertensive HI
3/M/52	1:08	IPH	No	Hypertensive HI
4/M/56	3:47	IPH	No	Hypertensive HI
5/F/58	1:36	IPH	Yes	HI
6/F/61	5:06	IPH	Yes	Septic emboli with HI
7/F/61	2:24	SAH, IPH	Yes	Lung cancer with hemorrhagic metastasis and separate infarct
8/M/66	0:48	IPH	No	Coagulopathy related to CLL with HI
9/M/68	6:30	IPH	Yes	HI
10/F/68	2:37	IPH	No	Hypertensive HI
11/F/70	0:55	IPH	No	Coagulopathy (anticoagulation)
12/M/70	2:00	IPH	Yes	HI
13/M/71	1:16	IPH	Unlikely	NED
14/F/74	6:46	IPH	Yes	HI
15/M/74	14:32	IPH	Yes	HI
16/M/76	1:52	IPH	Yes	HI
17/F/81	3:07	IPH	No	Amyloid angiopathy
18/F/82	0:29	IPH	No	Hypertensive HI
19/F/84	3:21	IPH	No	Hypertensive HI or vascular
20/F/84	1:27	IPH	No	Hypertensive HI
21/F/86	1:22	IPH	No	NED
22/F/88	1:54	IPH	Yes	HI
23/M/88	1:15	IPH	No	Hypertensive HI
24/M/88	1:23	IPH	Unlikely	NED
25/M/91	3:03	SDH	Unknown	NED

Note.—No patient in this group had a lacunar stroke. CLL indicates chronic lymphoid leukemia; IPH, intraparenchymal hemorrhage; SAH, subarachnoid hemorrhage; SDH, subdural hemorrhage; HI, hemorrhagic infarct; NED, no etiology determined despite follow-up.
* Computed tomography time after presentation to the emergency department.
† Comments on the character of the infarct and the most likely etiology based on imaging characteristics and clinical and follow-up data.