Discrimination of ischemic versus hemorrhagic stroke type by presenting symptoms or signs: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-05 DOI:10.1016/j.jstrokecerebrovasdis.2025.108413

Clodagh M McDermott MSc , Allie Seminer , Sinéad Comer , Alfredi Mulihano , Catriona Reddin MSc , Conor Judge PhD , Maria Costello PhD , Michelle Canavan PhD , Andrew Smyth PhD , Paul Hurley PhD , Finn Krewer PhD , Martin J O’Donnell PhD

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引用次数: 0

Abstract

Background

Valid discrimination of ischemic and hemorrhagic stroke relies exclusively on neuroimaging. Novel biomarkers in acute stroke present an opportunity to reconsider combination diagnostic approaches with standardized clinical assessment. Our systematic review evaluates diagnostic properties of acute clinical features in determining primary stroke etiology.

Methods

We conducted a systematic review and meta-analysis according to PRISMA guidelines. PubMed and EMBASE were searched from inception to 6^th March 2025. Eligibility criteria included cohort, cross-sectional, case-control, or randomised controlled trial; consecutive adults with an acute stroke confirmed by neuroimaging; and one or more acute stroke symptom(s) or sign(s) recorded by stroke subtype. A random-effects model was used to pool odds ratios.

Results

A total of 60 studies, (n = 12,879,006; ischemic stroke = 10,814,474; hemorrhagic stroke = 2,064,532), were eligible. Mean age was 70.45 ± 14.36 years and 51.9 % were women. Clinical presenting symptoms/signs associated with significantly higher odds of hemorrhagic stroke (compared to ischemic stroke) included coma (odds ratio 8.81 [95 % confidence interval, 5.02–15.45]), neck stiffness (5.21 [2.22–12.21]), Glasgow Coma Scale ≤8 (4.37 [2.35–8.16]), vomiting (3.86 [2.71–5.49]), altered consciousness (3.55 [2.55–4.95]), headache (3.49 [2.63–4.64]), syncope (2.74 [1.96–3.83]), seizure (2.67 [1.72–4.15]), abnormal plantar response (1.94 [1.24–3.04]) and vertigo/dizziness (1.32 [1.04–1.68]). Clinical symptoms/signs associated with significantly lower odds of hemorrhagic stroke included morning onset (0.41 [0.32–0.54]), facial weakness (0.66 [0.46–0.94]), hemiplegia (0.68 [0.50–0.91]), and ataxia (0.73 [0.61–0.86]).

Conclusion

Our review reports substantive differences in prevalence of stroke symptoms and signs between ischemic and hemorrhagic stroke subtypes.

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通过症状或体征区分缺血性和出血性脑卒中类型：一项系统回顾和荟萃分析

背景：缺血性和出血性脑卒中的有效鉴别完全依赖于神经影像学。急性卒中的新生物标志物提供了一个重新考虑联合诊断方法与标准化临床评估的机会。我们的系统综述评估了急性临床特征在确定原发性卒中病因中的诊断特性。方法：我们根据PRISMA指南进行了系统回顾和荟萃分析。PubMed和EMBASE从成立到2025年3月6日进行检索。入选标准包括队列、横断面、病例对照或随机对照试验；经神经影像学证实的连续急性脑卒中成人；和一个或多个急性中风症状(s)或体征记录的中风亚型。采用随机效应模型汇总优势比。结果：共纳入60项研究，(n = 12,879,006；缺血性中风 = 10814474;出血性中风 = ，2,064,532)。平均年龄70.45±14.36岁，女性占51.9%。出血性卒中（与缺血性卒中相比）的临床表现包括昏迷（优势比为8.81[95%可信区间，5.02-15.45]）、颈部僵硬（5.21[2.22-12.21]）、格拉斯哥昏迷量表≤8（4.37[2.35-8.16]）、呕吐（3.86[2.71-5.49]）、意识改变（3.55[2.55-4.95]）、头痛（3.49[2.63-4.64]）、晕厥（2.74[1.96-3.83]）、癫痫发作（2.67[1.72-4.15]）、足底反应异常（1.94[1.24-3.04]）和眩晕/头晕（1.32[1.04-1.68]）。出血性卒中的临床症状/体征包括晨起（0.41[0.32-0.54]）、面部无力（0.66[0.46-0.94]）、偏瘫（0.68[0.50-0.91]）和共济失调（0.73[0.61-0.86]）。结论：我们的综述报告了缺血性和出血性卒中亚型之间卒中症状和体征患病率的实质性差异。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.