The first scientifically proven treatments for intracerebral hemorrhage, or "bleeding," strokes, are on the horizon, including a new drug that holds promise for slowing bleeding and limiting brain damage resulting from such a stroke, according to updated American Heart Association/American Stroke Association guidelines.
The guidelines, published in Stroke: Journal of the American Heart Association, also address the feasibility and timing of surgical options and different ways to take pictures of the brain to diagnose a hemorrhagic stroke, as well as offer guidance on end-of-life issues such as putting "do-not-resuscitate" orders on hold for a full day after such a stroke occurs.
Intracerebral hemorrhage (ICH) is a stroke caused when a defective artery in the brain bursts, flooding the surrounding tissue with blood. ICH accounts for less than 10 percent of first-ever strokes, with 35 percent to 52 percent of patients dying within a month. Of the estimated more than 60,000 patients who have an ICH in a year, only 20 percent are expected to be functionally independent six months afterwards.
Reducing high blood pressure is still the best way to avoid ICH, said Joseph Broderick, M.D., chair of the guideline writing committee and professor and chairman in the neurology department of the University of Cincinnati.
"ICH is the second most common type of stroke and its incidence is staying the same or slightly increasing," he said. "The time is right for updating the guidelines because there have been a number of published studies that may affect how we manage these very sick patients."
When the AHA/ASA published guidelines for managing ICH in 1999, researchers had conducted only five small, randomized medical studies and four small, randomized surgical trials for acute ICH. In the past six years, 15 pilot and larger randomized medical and surgical trials for ICH/intraventricular hemorrhage (IVH) have been completed or are ongoing.
Surgery
Since the last Guidelines for Management of ICH were published, researchers have completed the largest ever surgical trial of intracerebral hemorrhage, Broderick said.
"We have a better understanding of when and when not to use surgery but we still need more trials," he said. "We don't recommend routine surgical treatment of ICH, but people who have larger blood clots close to the surface of the brain may be an exception."