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Brain scan checklist set to boost care for stroke survivors

Aug 2018: New research suggests that people who suffer a stroke caused by bleeding in the brain could be helped by four simple checks of their brain scans.

Professor Rustam Al-Shahi Salman and team have published research that could improve outcomes for the millions of people around the world who experience a brain bleed each year. The checks could help spot people at risk of further bleeding so they can be monitored more closely.

Bleeding in the brain – known as an intracerebral haemorrhage or ICH – is the most deadly form of stroke. Only one in five patients survives without permanent damage. Of the remainder, half are likely to die within a month and half will be left with a long-term disability.

Cases of ICH are diagnosed by brain scans, but until now it has been difficult to predict which patients will continue bleeding. Those who do are expected to have worse outcomes.

The research team, which was led from the University of Edinburgh and involved dozens of research centres worldwide, analysed data from studies involving more than 5,000 patients. The team identified four factors that helped predict whether patients were likely to experience further bleeding. These include the size of the bleed and whether or not the patient was taking medication, such as aspirin or warfarin, to thin their blood or prevent clotting.

Researchers also looked at the benefit of an advanced brain scanning technique – called CT angiography – for predicting a person’s risk of ongoing bleeding. The scan involves injecting a coloured dye into the patient’s bloodstream and checking if it can be seen leaking into the brain. For patients who showed leakage of the dye, the test was of little value in addition to the four simple checks for predicting their risk of ongoing bleeding.

Incorporating the four checks into patient care could help to improve survival, especially in low or middle-income countries, where patients may not have access to CT angiography.

We have found that four simple measures help doctors to make accurate predictions about the risk of a brain haemorrhage growing. These can be used anywhere in the world. Better prediction can help us identify which patients might benefit from close monitoring and treatment. We hope that an app could help doctors to do this. The next step is to find an effective treatment to stop the bleeding.

Professor Rustam Al-Shahi SalmanCentre for Clinical Brain Sciences, University of Edinburgh

The research, published in The Lancet Neurology, was funded by the UK’s Medical Research Council and the British Heart Foundation.

Related links

Read the scientific article in Lancet Neurology: Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data.  doi.org/10.1016/S1474-4422(18)30253-9

Professor Rustam al-Shahi Salman's profile

Research to Understand Stroke due to Haemorrhage (RUSH)