Ischemic Stroke vs Hemorrhagic Stroke
Giving tPA to a hemorrhagic stroke patient accelerates fatal bleeding. Giving nothing to an ischemic stroke patient lets brain tissue die. The CT scan result flips your entire plan — choosing wrong is catastrophic, and the NCLEX knows it.
Side-by-side comparison
Side-by-side2 compared
Dimension
Ischemic Stroke
Hemorrhagic Stroke
Pathophysiology
- Clot blocks a cerebral artery
- ~87% of all strokes
- Vessel ruptures, bleeds into brain
- ~13% of all strokes
Signs & symptoms
- Gradual/stuttering onset; mild or no headache
- Sudden explosive onset; thunderclap headache
CT scan (acute)
- CT negative for blood (rules out bleed pre-tPA)
- Blood visible immediately on CT
Priority nursing actions
- Activate stroke team; CT STAT
- Assess tPA eligibility; neuro checks q15 min
- Activate stroke team; CT STAT
- Manage BP & ICP; prep surgery; neuro q15 min
Treatment — opposite!
- ★tPA/alteplase if within 4.5 hr + CT clear
- Thrombectomy ≤24 hr; antiplatelets, statin
- ★tPA CONTRAINDICATED — worsens bleed
- Reverse anticoagulation; nimodipine for SAH
BP teaching & prevention
- ★Permissive HTN pre-tPA ≤220/120; <180/105 after
- Adhere to antiplatelets; control risk factors
- ★Lower BP aggressively; SBP < 140
- Avoid Valsalva; manage HTN long-term
Red flags — escalate
- Cerebral edema → ↑ ICP after large infarct
- Bleeding signs post-tPA → hold, CT
- High ICP expected — elevate HOB 30°
- Head midline; rebleed/herniation signs
Complications
- Lower acute seizure risk
- Hemorrhagic conversion after reperfusion
- Higher seizure risk — blood irritates cortex
- Rebleed, vasospasm (SAH), hydrocephalus
Pathophysiology
Ischemic Stroke
- Clot blocks a cerebral artery
- ~87% of all strokes
Hemorrhagic Stroke
- Vessel ruptures, bleeds into brain
- ~13% of all strokes
Signs & symptoms
Ischemic Stroke
- Gradual/stuttering onset; mild or no headache
Hemorrhagic Stroke
- Sudden explosive onset; thunderclap headache
CT scan (acute)
Ischemic Stroke
- CT negative for blood (rules out bleed pre-tPA)
Hemorrhagic Stroke
- Blood visible immediately on CT
Priority nursing actions
Ischemic Stroke
- Activate stroke team; CT STAT
- Assess tPA eligibility; neuro checks q15 min
Hemorrhagic Stroke
- Activate stroke team; CT STAT
- Manage BP & ICP; prep surgery; neuro q15 min
Treatment — opposite!
Ischemic Stroke
- ★tPA/alteplase if within 4.5 hr + CT clear
- Thrombectomy ≤24 hr; antiplatelets, statin
Hemorrhagic Stroke
- ★tPA CONTRAINDICATED — worsens bleed
- Reverse anticoagulation; nimodipine for SAH
BP teaching & prevention
Ischemic Stroke
- ★Permissive HTN pre-tPA ≤220/120; <180/105 after
- Adhere to antiplatelets; control risk factors
Hemorrhagic Stroke
- ★Lower BP aggressively; SBP < 140
- Avoid Valsalva; manage HTN long-term
Red flags — escalate
Ischemic Stroke
- Cerebral edema → ↑ ICP after large infarct
- Bleeding signs post-tPA → hold, CT
Hemorrhagic Stroke
- High ICP expected — elevate HOB 30°
- Head midline; rebleed/herniation signs
Complications
Ischemic Stroke
- Lower acute seizure risk
- Hemorrhagic conversion after reperfusion
Hemorrhagic Stroke
- Higher seizure risk — blood irritates cortex
- Rebleed, vasospasm (SAH), hydrocephalus
★ marks the fact that sets a column apart.
Clinical Pearl
No blood on CT → clot → tPA candidate. Blood on CT → bleed → tPA kills.
Play this as a game — free
Drill Ischemic Stroke vs Hemorrhagic Stroke in Swipe Right & Speed Sort. 14-day free trial, no card required.