Ischemic stroke vs Hemorrhagic stroke
How to tell Ischemic stroke and Hemorrhagic stroke apart when a board question makes them look alike.
Ischemic stroke: deficit with a normal early noncontrast CT; hemorrhagic stroke: deficit with headache, vomiting, and hyperdense blood on CT.
Side by side
Sudden focal deficit from vessel occlusion, often without severe headache.
Bleeding with severe headache, vomiting, depressed consciousness, or very high blood pressure.
Thrombotic or embolic arterial occlusion causes infarction.
Vessel rupture causes intraparenchymal or subarachnoid bleeding.
Noncontrast CT may be initially normal or show ischemic changes.
Noncontrast CT shows acute blood; lumbar puncture may show xanthochromia after subarachnoid bleed.
The trap
A focal neurologic deficit at the bedside does not split ischemic from hemorrhagic stroke. Even thunderclap headache and a stiff neck are not specific. Never give tPA on history alone. The noncontrast head CT to exclude blood is the only acceptable first step, and the 4.5-hour tPA window keeps closing whether or not you delay imaging.
Watch it explained
The repair move
Get imaging before thrombolysis; treatment for ischemia is unsafe until hemorrhage is excluded.
Try a free question
CoreA patient with atrial fibrillation suddenly develops aphasia and right arm weakness without severe headache. Which stroke mechanism is most likely?
Show answer and explanation
Answer: A. Ischemic stroke. Abrupt focal deficit in atrial fibrillation suggests embolic ischemic stroke.
Why the other choices are tempting
- B. Hemorrhagic stroke more often has headache, vomiting, depressed consciousness, or severe hypertension clues.
- C. Subarachnoid hemorrhage causes sudden severe headache.
- D. Migraine aura is usually transient and stereotyped with headache history.
- E. Bell palsy is a peripheral facial nerve palsy, not aphasia/arm weakness.
Flashcards
Tap a card to flip it.
What is the fastest separator for Ischemic stroke vs Hemorrhagic stroke?
Ischemic stroke: deficit with a normal early noncontrast CT; hemorrhagic stroke: deficit with headache, vomiting, and hyperdense blood on CT.
What clue should make you choose Ischemic stroke?
Sudden focal deficit from vessel occlusion, often without severe headache.
Quick answers
What is the fastest way to tell Ischemic stroke from Hemorrhagic stroke?
Ischemic stroke: deficit with a normal early noncontrast CT; hemorrhagic stroke: deficit with headache, vomiting, and hyperdense blood on CT.
What is the key clue for Ischemic stroke?
Sudden focal deficit from vessel occlusion, often without severe headache.
What is the key clue for Hemorrhagic stroke?
Bleeding with severe headache, vomiting, depressed consciousness, or very high blood pressure.
What is the common trap with Ischemic stroke vs Hemorrhagic stroke?
A focal neurologic deficit at the bedside does not split ischemic from hemorrhagic stroke. Even thunderclap headache and a stiff neck are not specific. Never give tPA on history alone. The noncontrast head CT to exclude blood is the only acceptable first step, and the 4.5-hour tPA window keeps closing whether or not you delay imaging.