Stroke symptoms vomiting
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Summary
10 papers analyzed
These studies suggest vomiting can be an early predictor of stroke, particularly in ischemic brainstem and hemorrhagic strokes, and may lead to misdiagnosis or indicate severe complications.
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Vomiting as a Symptom and Predictor in Stroke Patients
Prevalence of Vomiting in Different Types of Stroke
Vomiting is a common symptom in stroke patients, but its prevalence varies significantly across different types of strokes. In a study involving 1968 confirmed stroke patients, vomiting was observed in 14.5% of all cases. When broken down by stroke type, vomiting occurred in 8.7% of cerebral infarction (CI) cases, 23.7% of cerebral hemorrhage (CH) cases, and 36.8% of subarachnoid hemorrhage (SAH) cases. This indicates that vomiting is more frequently associated with hemorrhagic strokes compared to ischemic strokes.
Vomiting as a Diagnostic Challenge
Vomiting can sometimes be a prominent symptom in ischemic brainstem strokes, even when other neurological abnormalities are minimal or absent. This can lead to misdiagnosis, as the symptom might be mistaken for a gastrointestinal disorder rather than a stroke. This highlights the importance of considering stroke in the differential diagnosis when patients present with unexplained vomiting, especially in the absence of other common stroke symptoms.
Vomiting and Stroke Outcomes
The presence of vomiting at the onset of a stroke is associated with a higher risk of mortality. In the same study mentioned earlier, the hazard ratio (HR) for death was significantly higher in patients with vomiting compared to those without. The HR for death was 5.06 for all stroke patients, 5.27 for CI, 2.82 for CH, and 5.07 for SAH. This suggests that vomiting can be an early predictor of poor outcomes in stroke patients.
Unique Stroke Symptoms in Women
Women may experience unique stroke symptoms, including nausea and vomiting, more frequently than men. This can lead to delays in recognition and treatment, as these symptoms are not always immediately associated with stroke by healthcare professionals or the general population. Improving awareness and diagnostic tools to recognize these unique symptoms could help reduce misdiagnosis and improve outcomes for female stroke patients.
Vomiting in Hemorrhagic Stroke
In hemorrhagic strokes, vomiting is a common symptom and is often accompanied by other signs such as headache and altered consciousness. These symptoms can worsen within the first 24-72 hours, necessitating immediate emergency care. Accurate and prompt diagnosis is crucial to manage these patients effectively and prevent further complications.
Vomiting and Fatal Brain Swelling
Vomiting within the first 24 hours after stroke onset is also an independent predictor of fatal brain swelling. Patients with high baseline National Institutes of Health Stroke Scale (NIHSS) scores and vomiting are at a significantly higher risk of developing fatal brain edema. This underscores the importance of early identification and aggressive management of stroke patients presenting with vomiting.
Conclusion
Vomiting is a significant symptom in stroke patients, with its prevalence and implications varying across different types of strokes. It can be a diagnostic challenge, particularly in ischemic brainstem strokes, and is associated with higher mortality rates. Recognizing vomiting as a potential stroke symptom, especially in women and in the context of hemorrhagic strokes, is crucial for timely and accurate diagnosis and treatment. Early identification of vomiting can also help predict and manage severe complications such as fatal brain swelling.
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