Hemorrhagic strokes include intracerebral, subdural, and subarachnoid hemorrhages. They are the result of bleeding into the brain or the surrounding spaces and are associated with hypertension, bleeding disorders, aneurysm rupture, and drug use. Anticoagulants and thrombolytic agents are commonly indicated, as well as drugs of abuse such as cocaine, methamphetamine, ecstasy, ephedrine, phenylpropanolamine, and heroin.
Ischemic strokes are predominantly either thrombotic or embolic. Thrombotic strokes occur secondary to arterial thrombus formation, which either reduces distal blood flow to the brain or causes complete occlusion. Embolic strokes often occur when an embolus develops due to cardiac arrhythmias, atrial fibrillation, atrial flutter, or cardiac structural abnormalities and then blocks brain arterial blood flow. Antipsychotics (quetiapine, zotepine, valproic acid), menopausal hormone therapy, oral contraceptives, and cannabis use have been linked with ischemic stroke.
Findings present suddenly and depend on the area of the brain that is affected. They include unilateral numbness or weakness occurring in the face, arms, or legs. Acute confusion, speech abnormalities, vision field defects, gaze deviation, gait disturbance, ataxia, poor balance, dizziness, severe headache, nausea, vomiting, altered mental status, and loss of consciousness may also occur. Seizures may also be a presenting symptom. In cases of subdural hemorrhage, symptoms may develop more subacutely.
Drug-induced stroke etiology can include induced hypertension, vasoconstriction, impaired coagulation, vasculopathy, disturbed heart function, or increased risk of endocarditis.
Related topics: cerebellar stroke, brain stem stroke
I63.9 – Cerebral infarction, unspecified
230690007 – Cerebrovascular accident
Differential Diagnosis & Pitfalls
- Cerebral stroke
- Intracerebral hemorrhage
- Subarachnoid hemorrhage
- Transient ischemic attack
- Cerebellar stroke
- Cerebellar infarction
- Cerebellar hemorrhage
- Brain stem stroke
- Basilar artery occlusion
- Seizure with postictal paralysis
- Migraine with hemiparesis
- Somatic symptom and related disorders (eg, conversion disorder)
- Hypertensive encephalopathy
- Central nervous system tumor
- Pituitary apoplexy
Drug Reaction Data