Hemorrhagic and Ischemic Strokes Compared

Abstract

Background and Purpose-Stroke patients with hemorrhagic (HS) and ischemic strokes were compared with regard to stroke severity, mortality, and cardiovascular risk factors. Methods-A registry started in 2001, with the aim of registering all hospitalized stroke patients in Denmark, now holds information for 39 484 patients. The patients underwent an evaluation including stroke severity (Scandinavian Stroke Scale), CT, and cardiovascular risk factors. They were followed-up from admission until death or censoring in 2007. Independent predictors of death were identified by means of a survival model based on 25 123 individuals with a complete data set. Results-Of the patients 3993 (10.1%) had HS. Stroke severity was almost linearly related to the probability of having HS (2% in patients with the mildest stroke and 30% in those with the most severe strokes). Factors favoring ischemic strokes vs HS were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall higher mortality risk (HR, 1.564; 95% CI, 1.441-1.696). The increased risk was, however, time-dependent; initially, risk was 4-fold, after 1 week it was 2.5-fold, and after 3 weeks it was 1.5-fold. After 3 months stroke type did not correlate to mortality. Conclusion-Strokes are generally more severe in patients with HS. Within the first 3 months after stroke, HS is associated with a considerable increase of mortality, which is specifically associated with the hemorrhagic nature of the lesion.

Prestroke Alcohol Consumption and Smoking Are Not Associated with Stroke Severity, Disability at Discharge, and Case Fatality

“…[17][18][19] Smoking and heavy alcohol consumption are well-known risk factors for stroke, 7,20,21 but few studies examined the relationship between stroke severity or outcome and prestroke smoking status or alcohol consumption. By the analysis of close to a thousand acute stroke cases from 3 Central-Eastern European countries, we tested whether prestroke smoking or alcohol consumption habits significantly influence initial stroke severity, disability at discharge from hospital, and case fatality at 30 days and at 1 year.…”

“…The median NIHSS score was similar in the total group and in those with ischemic stroke, in smokers and nonsmokers, and in alcohol consumers and nonconsumers/light consumers. We categorized strokes by the NIHSS score as mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19)(20)(21)(22), and very severe (.23). There was no difference in the distribution of patients among these severity categories between smokers and nonsmokers (P 5 .71) and alcohol consumers and nonconsumers (P 5 .65; Fig 1).…”

Clinical and Demographic Properties of the Acute Stroke Patients Admitted to Emergency Department of a Tertiary Referral Center

“…Furthermore, there was no significant difference between female and male patients in terms of stroke type. In a comprehensive study conducted in 2009 by screening approximately 40,000 stroke patients, there was no significant difference between male and female patients in terms of rates of hemorrhagic and ischemic stroke (15). Other studies examining patients hospitalized in stroke units determined no significant difference in terms of stroke severity and type (16,17).…”

Dietary fibre intake and risk of ischaemic and haemorrhagic stroke in the UK Women’s Cohort Study

“…Post-hoc exploration of stroke types was undertaken as estimates from other studies 87 indicate the majority of first stroke events are ischaemic in type (4,6). A new case group was created 88 that included ischaemic plus unspecified strokes, with the assumption being that the majority of 89 stroke events in this case group would be ischaemic in type.…”

“…This approach is especially important for stroke 270 because risk factors for the two main types differ (6). Combining ischaemic with the unknown type 271 stroke cases provided narrower CIs around risk estimates but a limitation with this approach is that 272 some sensitivity may be lost through including a small number of unidentified haemorrhagic stroke 273 cases into this category.…”