TY - JOUR T1 - Specific clinical findings, including coma, neck stiffness and seizures, increase the likelihood of haemorrhagic stroke, but no combination of features is definitively diagnostic JF - Evidence Based Medicine JO - Evid Based Med SP - 183 LP - 184 DO - 10.1136/ebm1121 VL - 15 IS - 6 AU - Michael D Hill Y1 - 2010/12/01 UR - http://ebm.bmj.com/content/15/6/183.abstract N2 - Commentary on: Runchey S, McGee S. Does this patient have a hemorrhagic stroke?: clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA 2010;303:2280–6.OpenUrlCrossRefPubMed 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 … ER -