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Systematic review
Specific clinical findings, including coma, neck stiffness and seizures, increase the likelihood of haemorrhagic stroke, but no combination of features is definitively diagnostic
  1. Michael D Hill
  1. University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Michael D Hill
    Rm 1242A, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada; michael.hill{at}

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Stroke presentations should be conceptualised as stroke syndromes, much in the same way that we now think about acute coronary syndromes. The clinical manifestations reflect brain dysfunction, but not necessarily the underlying cause. Ischaemic stroke is the most common stroke type, comprising 65–85% of all stroke, varying by location in the world. Ischaemic stroke is potentially treatable with systemic and endovascular thrombolysis, or minimally with antithrombotic medication (ie, ASA). In contrast, such treatment is inappropriate in the hyperacute setting for the two main haemorrhagic forms of stroke – intracerebral haemorrhage (ICH) and subarachnoid haemorrhage. In the emergency evaluation of patients, it is, therefore, critical to know whether the patient has an ischaemic or haemorrhagic stroke. The definitive way to know this is brain imaging, conventionally with CT or MR. With rare exceptions, both CT and MR are fixed resources located at hospitals. The availability of such imaging is widespread in most …

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  • Competing interests MDH has been a consultant to NovoNordisk Canada and received honoraria from GE Healthcare Canada.