Literature review: Clinical findings cannot distinguish hemorrhagic from ischemic stroke

This study's authors conducted a literature review to determine the accuracy of bedside clinical findings in distinguishing hemorrhagic and ischemic stroke. The diagnostic accuracy of bedside findings has never been systematically reviewed.

The study's results were based on 19 prospective studies in which initial clinical findings were compared with diagnostic standards for hemorrhagic stroke of neuroimaging or autopsy.

Several clinical findings increased the probability of hemorrhagic stroke: coma, neck stiffness, seizures, diastolic blood pressure greater than 110 mm Hg, vomiting and headache. Cervical bruit and prior transient ischemic attack decreased hemorrhagic stroke probability.

However, the results indicate that many stroke patients lack any diagnostic findings or are unclassifiable by stroke scores. Neither the clinical impression of experienced clinicians nor the most accurate stroke score can improve the posttest probability of hemorrhage to greater than 50 percent.

While combinations of findings are more predictive than individual findings, the study's results indicate that no clinical findings are absolutely diagnostic in distinguishing hemorrhagic from ischemic stroke and diagnostic certainty requires neuroimaging.