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Two simple tests could help to pinpoint cause of stroke

Jan 2018: CCBS researchers suggest that detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan.

CCBS researchers Dr Mark Rodrigues, Professor Rustam Al-Shahi Salman and colleagues have published  findings suggesting that a genetic test for APOE combined with a CT scan could be used to detect stroke caused by intracerebral haemorrhage (ICH).

ICH accounts for up to 50 per cent of all strokes worldwide. Around half of those affected die within one year.

ICH can be caused by a condition called cerebral amyloid angiopathy (CAA). CAA is caused by a build-up of a protein known as amyloid in the walls of blood vessels in the brain. It is linked to a higher risk of further strokes and dementia.

The researchers used computed tomography (CT) scans in more than 100 patients who died following their first ICH. They collected blood samples to test the APOE gene, which is linked to CAA.

By combining simple CT scan images with a genetic blood test, researchers could accurately spot if an ICH had been caused by CAA.

Combining the test with a brain scan could provide key genetic information that may help identify those most at risk from a second stroke.

This new approach could help identify people who are at higher risk after their ICH, revolutionising the way doctors manage this type of stroke.

It could also improve ICH diagnosis in developing countries, as CT scanning and blood testing are available worldwide.

Identifying the cause of a brain haemorrhage is important to planning patient care. Our findings suggest that the combination of routine CT scanning with APOE gene testing can identify those whose ICH has been caused by CAA – a group who may be more at risk of another ICH or dementia.

Dr Mark RodriguesWellcome Trust Clinical PhD Programme Fellow, Centre for Clinical Brain Sciences

The study is published in Lancet Neurology and was funded by the Medical Research Council, Stroke Association and Wellcome Trust.

Related links

Read the scientific paper: Rodrigues et al., The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurology, published online 10th Jan 2018.  dx.doi.org/10.1016/S1474-4422(18)30006-1

Graphics related to the publication on Edinburgh Datashare

Research to Understand Stroke Due to Haemorrhage (RUSH) research programme

Professor Rustam Al-Shahi Salman Principal Investigator profile

CCBS research into stroke and brain vascular disease

CCBS neuroimaging research

CCBS neuropathology and brain banking research

Edinburgh Imaging