Clinical differentiation between ischaemic and haemorrhagic strokes with computed tomographic correlations

ABSTRACT

We studied the clinical features of 64 stroke patients, 34 of ischaemic and 30 of haemorrhagic strokes as proved by computed tomography. History of transient ischaemic attack, diabetes and heart disease were commoner among patients of ischaemic stroke [IS] than those of intracerebral haemorrhage [ICH]. There was statistically significant difference between ischaemic and haemorrhagic stroke patients as regards history of hypertension and/or elevated blood pressure at onset, progression to a maximal neurologic deficit within an hour after onset, headache associating or preceding onset, disturbed consciousness, especially stupor or coma, neck rigidity, popilloedema, pupillary and eye gaze movement disorders, all in addition to vomiting were higher in cases of ICH. These findings associated larger haematomas with oedema, mass effect or intraventricular blood extension. A significant statistical correlation was observed between abrupt onset and shift of midline structures [P < 0.01], headache and size of haematoma [P < 0.05], neck rigidity and intraventricular extension of blood [P < 0.05] and between stupor or coma and size of haematoma [P < 0.01] and shift of midline structures [P < 0.01]. In IS, headache, vomiting, vertigo, neck rigidity and disturbed consciousness, when occurred, usually associated posterior fossa followed by extensive, or large supratentorial infarcts. Abrupt onset with headache was also observed in high proportion of embolic strokes. Convulsions associated or followed onset to relatively equal proportions in ICH and cerebral infacts [CI[s]], while speech difficulties were encountered in cases of CI [s] more than those of ICH. Non-fluent aphasic disturbances were correlated with lesions [haemorrhage or infarction] anterior to the rolandic fissure, while fluent aphasia was observed with lesions posterior to the rolandic fissure. Massive lesions at the same sites induced global aphasia