Brain scan checklist to improve care for stroke survivors

16 August 2018        

Category: Research

CT scans of a human head

People who suffer a haemorrhagic stroke, where there is bleeding in the brain, would benefit from better outcomes if their doctors used four simple checks of their brain scans.

New research published in The Lancet Neurology suggests these checks could help spot people at risk of further bleeding so they can be monitored more closely. The researchers say this could help improve outcomes for the millions of people around the world who experience a brain bleed each year.

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

A haemorrhagic stroke is usually diagnosed by brain scans, but it can be difficult to predict in which patients the bleeding will continue or a second bleed occur. This normally leads to worse outcomes.

Research led by the University of Edinburgh analysed data from studies around the world involving more than 5,000 patients. The team identified four factors that helped doctors 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.

Experts say the checks can be applied during routine care to help medical staff decide the best way to continue monitoring each patient.

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. But the team found the results offered little additional value beyond the four simple checks.

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.

Professor Rustam Al-Shahi Salman, BHF-funded study author based at the University of Edinburgh: “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.”

Read more about our stroke research