Shauna Runchey1, Steven McGee. 1. Department of Medicine, University of Washington, Box 356426, 1959 NE Pacific St, Health Sciences Bldg, Seattle, WA 98195-6426, USA. srunchey@u.washington.edu
Abstract
CONTEXT: The 2 fundamental subtypes of stroke are hemorrhagic stroke and ischemic stroke. Although neuroimaging is required to distinguish these subtypes, the diagnostic accuracy of bedside findings has not been systematically reviewed. OBJECTIVE: To determine the accuracy of clinical examination in distinguishing hemorrhagic stroke from ischemic stroke. DATA SOURCES: MEDLINE and EMBASE searches of English-language articles published from January 1966 to April 2010. STUDY SELECTION: Prospective studies of adult patients with stroke that compared initial clinical findings with accepted diagnostic standards of hemorrhagic stroke (computed tomography or autopsy). DATA EXTRACTION: Both authors independently appraised study quality and extracted relevant data. DATA SYNTHESIS: Nineteen prospective studies meeting inclusion criteria were identified (N = 6438 patients; n = 1528 [24%] with hemorrhage stroke). Several findings significantly increase the probability of hemorrhagic stroke: coma (likelihood ratio [LR], 6.2; 95% confidence interval [CI], 3.2-12), neck stiffness (LR, 5.0; 95% CI, 1.9-12.8), seizures accompanying the neurologic deficit (LR, 4.7; 95% CI, 1.6-14), diastolic blood pressure greater than 110 mm Hg (LR, 4.3; 95% CI, 1.4-14), vomiting (LR, 3.0; 95% CI, 1.7-5.5), and headache (LR, 2.9; 95% CI, 1.7-4.8). Other findings decrease the probability of hemorrhage: cervical bruit (LR, 0.12; 95% CI, 0.03-0.47) and prior transient ischemic attack (LR, 0.34; 95% CI, 0.18-0.65). A Siriraj score greater than 1 increases the probability of hemorrhage (LR, 5.7; 95% CI, 4.4-7.4) while a score lower than -1 decreases the probability (LR, 0.29; 95% CI, 0.23-0.37). Nonetheless, many patients with stroke lack any diagnostic finding, and 20% have Siriraj scores between 1 and -1, which are diagnostically unhelpful (LR, 0.94; 95% CI, 0.77-1.1). CONCLUSION: In patients with acute stroke, certain findings accurately increase or decrease the probability of intracranial hemorrhage, but no finding or combination of findings is definitively diagnostic in all patients, and diagnostic certainty requires neuroimaging.
CONTEXT: The 2 fundamental subtypes of stroke are hemorrhagic stroke and ischemic stroke. Although neuroimaging is required to distinguish these subtypes, the diagnostic accuracy of bedside findings has not been systematically reviewed. OBJECTIVE: To determine the accuracy of clinical examination in distinguishing hemorrhagic stroke from ischemic stroke. DATA SOURCES: MEDLINE and EMBASE searches of English-language articles published from January 1966 to April 2010. STUDY SELECTION: Prospective studies of adult patients with stroke that compared initial clinical findings with accepted diagnostic standards of hemorrhagic stroke (computed tomography or autopsy). DATA EXTRACTION: Both authors independently appraised study quality and extracted relevant data. DATA SYNTHESIS: Nineteen prospective studies meeting inclusion criteria were identified (N = 6438 patients; n = 1528 [24%] with hemorrhage stroke). Several findings significantly increase the probability of hemorrhagic stroke: coma (likelihood ratio [LR], 6.2; 95% confidence interval [CI], 3.2-12), neck stiffness (LR, 5.0; 95% CI, 1.9-12.8), seizures accompanying the neurologic deficit (LR, 4.7; 95% CI, 1.6-14), diastolic blood pressure greater than 110 mm Hg (LR, 4.3; 95% CI, 1.4-14), vomiting (LR, 3.0; 95% CI, 1.7-5.5), and headache (LR, 2.9; 95% CI, 1.7-4.8). Other findings decrease the probability of hemorrhage: cervical bruit (LR, 0.12; 95% CI, 0.03-0.47) and prior transient ischemic attack (LR, 0.34; 95% CI, 0.18-0.65). A Siriraj score greater than 1 increases the probability of hemorrhage (LR, 5.7; 95% CI, 4.4-7.4) while a score lower than -1 decreases the probability (LR, 0.29; 95% CI, 0.23-0.37). Nonetheless, many patients with stroke lack any diagnostic finding, and 20% have Siriraj scores between 1 and -1, which are diagnostically unhelpful (LR, 0.94; 95% CI, 0.77-1.1). CONCLUSION: In patients with acute stroke, certain findings accurately increase or decrease the probability of intracranial hemorrhage, but no finding or combination of findings is definitively diagnostic in all patients, and diagnostic certainty requires neuroimaging.
Authors: Peter Kropp; Martin Holzhausen; Edwin Kolodny; Ulf Becker; Martin Dichgans; Exuperio Diez-Tejedor; Christian Enzinger; Franz Fazekas; Blanca Fuentes; Anna Karpinska; Wolfgang Meyer; Christian Tanislav; Tobias Böttcher; Arndt Rolfs Journal: J Neural Transm (Vienna) Date: 2013-06-09 Impact factor: 3.575
Authors: Aaron Berkowitz; Nirali Vora; Morgan L Prust; Deanna Saylor; Stanley Zimba; Fred Stephen Sarfo; Gentle S Shrestha Journal: Stroke Date: 2022-01-20 Impact factor: 7.914