Abstract
PURPOSE To explore the clinical differentiation of an ischemic stroke vs. a hemorrhagic stroke, and to illuminate the possibility of giving thrombolytic treatment of stroke based only on the history and clinical findings. METHODS By searches in PubMed, UpToDate and MedLine, a selection of literature was made by using keywords in different combinations. Keywords included were “stroke”, ”ischemic”, ”hemorrhage”, ”clinical diagnosis” and ”prognosis”. A total of 35 articles were selected. In addition, there was also a search made for background information. RESULTS The physician can to a certain extent, based on different factors distinguish between an ischemic and a hemorrhagic stroke. The anamnesis of performing physical activity during or before the stroke, coughing and sneezing favors a hemorrhagic stroke (1). Having a stroke after changing position to standing, favors an ischemic (embolic) situation. Sudden onset, severe symptoms and rapid progression of the symptoms favors a hemorrhagic episode, and in contrast symptoms that start and develop little by little are signs of an ischemic stroke (2). The occurrence of an ischemic stroke is 80% more common among elderly, and the hemorrhagic ones are 20%, which can be used to predict the likelihood of which type of stroke is present (3). Based on the clinical picture and anamnesis, the doctor can distinguish to a certain extant whether the stroke is due to hemorrhage or ischemia, but CT should be taken to prevent further complications. CONCLUSION The clinic of a stroke can only to a certain extent help to determinate whether a stroke is hemorrhagic or ischemic. A CT- scan should be taken firstly to exclude a hemorrhage before administrating thrombolysis.