Brain scan checklist set to boost care for stroke survivors

New research involving Professor Rustam Al-Shahi Salman (Centre for Clinical Brain Sciences) has found that those who suffer a stroke caused by bleeding in the brain could be helped by four simple checks of their brain scans which could help to spot people at risk of further bleeding.

This could help improve outcomes for the millions of people around the world each year who experience an intracerebral haemorrhage (bleeding in the brain). This is the deadliest form of stroke with only one in five patients surviving 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 intracerebral haemorrhage 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.

Researchers analysed data from studies around the world involving more than 5,000 patients and identified four factors that helped doctors predict whether patients were likely to experience further bleeding. These include the size of the bleed, the time from symptom onset to brain imaging, and whether or not the patient was taking anticoagulant or antiplatelet medication, such as aspirin or warfarin.

Furthermore, the benefit of the advanced brain scanning technique CT angiography for predicting a person’s risk of ongoing bleeding was also assessed by researchers. CT angiography involves injecting a coloured dye into the patient’s bloodstream which allows the visualisation of blood vessels in the body. It was found that for patients who showed leakage of the dye into the brain, the test was of little value in addition to the four simple checks for predicting their risk of ongoing bleeding.

By incorporating these four checks during routine care, this could help medical staff to determine the best way to continue monitoring each patient and could also help improve survival, especially in low or middle-income countries, where patients may not have access to CT angiography.

Dozens of research centres worldwide contributed to this study, which is the largest of its kind to date. This research, published in The Lancet Neurology, was funded by the UK’s Medical Research Council and the British Heart Foundation.

Professor Rustam Al-Shahi Salman said: “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.”