• M da M Gomes, M F Costa, C André, R Gomes, and S A Novis.
• Hospital Universitário Clementino Fraga Filho, Department of Internal Medicine-Neurology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Brasil.
• Arq Neuropsiquiatr. 1998 Sep 1; 56 (3B): 523-7.

ObjectiveTo evaluate the accuracy of clinical unstructured and structured diagnosis of acute stroke subtypes--cerebral haemorrhage (CH), cerebral infarction (CI), subarachnoid haemorrhage (SAH).MethodsSixty consecutive patients with acute stroke admitted to the Emergency Ward of a Brazilian University Hospital were examined by emergency physicians and computerised tomography (CT). We also compared it (physician's unstructured diagnosis) to two published clinical scoring systems (structured diagnosis--Guy's Hospital and Siriraj Hospital) applied to three other populations--regarding the operational characteristics of the tests.ResultsIn our personal data, among 9 variables that could discriminate CH and CI, three have statistically significant difference (p < 0.05): headache (p = 0.0002) and vomiting (p = 0.02) occurred more frequently in CH patients, but previous stroke in those with CI (p = 0.04). Unstructured diagnosis proved valid for SAH, with a +LHR = 39.7; and to a smaller degree for CI (-LHR = 0.1). However, it exhibited low sensitivity for the diagnosis of CH. Structured tests (Guy's Hospital and Siriraj Hospital) also failed to confidently diagnose stroke subtypes, especially CH.ConclusionsBoth clinical diagnosis (made by emergency physicians) and the available diagnostic tests fail to confidently discriminate CH and CI.

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