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Key Features

Essentials of Diagnosis

  • Sudden onset of subarachnoid or intracerebral hemorrhage

  • Distinctive neurologic signs reflect the region of the brain involved

  • Signs of meningeal irritation in patients presenting with subarachnoid hemorrhage

  • Seizures or focal deficits may occur

General Considerations

  • See Table 24–3

  • Congenital vascular malformations

    • Result from a localized maldevelopment of part of the primitive vascular plexus

    • Vary in size, ranging from massive lesions fed by multiple vessels to small lesions that are hard to identify at arteriography, surgery, or autopsy

  • Symptoms may relate to hemorrhage or to cerebral ischemia due to diversion of blood by the anomalous arteriovenous shunt or venous stagnation

  • Most cerebral arteriovenous malformations (AVMs) are supratentorial and in the middle cerebral artery territory

  • Infratentorial lesions include brainstem or cerebellar AVMs

  • Small AVMs are more likely to bleed than large ones

  • AVM that have bled once are more likely to bleed again

  • Bleeding is unrelated to sex or lesion site

  • Hemorrhage is intracerebral and subarachnoid (with 10% of cases fatal)

Table 24–3.Features of the major stroke subtypes.

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