ULTRA-EARLY EVALUATION OF INTRACEREBRAL HEMORRHAGE

Project: Research project

Description

Spontaneous intracerebral hemorrhage (ICH)is a major public health
problem,involving approximately 31,500 Americans yearly and
resulting in more than 15,000 deaths. Approximately one of 10
strokes in an ICH. Benefit has not been established for any
specific medical or surgical therapy. In an ongoing study of hyper-acute therapy for cerebral infarction
using tissue plasminogen activator, 20 percent of the patients
arriving for care within 60 minutes of symptom onset have been
excluded because of ICH. Active intracerebral bleeding was
documented by the Principal Investigator for two of these patients.
For one of thee patients, the active bleeding preceded clinical
deterioration. These two cases plus documented active bleeding in
three other cases in Cincinnati prompted the investigators to
review prior studies regarding the temporal profile of continued
bleeding in the setting of spontaneous intracerebral hemorrhage.
Unfortunately, this question has not been appropriately addressed. If active bleeding continues for 1-6 hrs following onset of
spontaneous intracerebral hemorrhage, there may exist a
"therapeutic window" during which therapeutic maneuvers such as
blood pressure adjustment, administration of antifibrinolytic
therapy, or ultra-early surgical evaluation may hold promise. We
propose performing hyper-acute evaluation of all stroke patients
at 7 major Cincinnati hospitals so as to identify patients with
ICH. Patients who are examined with computed tomography (CT)
within 3 hours of symptom onset will be examined with a standard
neurological examination score. The CT scan will then be repeated
3 times -- 60 minutes after the first CT, 6 hours from symptom-
onset, and 20 hours from symptom-onset. The standard neurological
examination will also be repeated at those times. Data will be
gathered on each patient regarding the risk factors for ICH,
coagulation and fibrinolytic parameters, and frequent blood
pressure measurements. Fifty-two patients will be studied over a
30-month period. Patients who expire will be examined at
postmortem to determine the primary diagnosis and to determine, if
possible, the reason for hemorrhage growth (if active in-hospital
bleeding has been documented prior to death). The primary study objectives are: 1) to determine the percentage
of patients with ICH who have CT evidence of continued bleeding
during the first hours after onset, and 2) to determine whether CT
evidence of continued bleeding correlates with early clinical
deterioration.
StatusFinished
Effective start/end date12/1/8811/30/94

Funding

  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health: $117,125.00
  • National Institutes of Health: $190,775.00
  • National Institutes of Health

Fingerprint

Cerebral Hemorrhage
Hemorrhage
Stroke
Growth
Tomography
Basal Ganglia Hemorrhage
Glasgow Coma Scale
Mortality
Brain Edema
Research Personnel
Therapeutics
Thalamus
Edema
Tissue Plasminogen Activator
Blood Pressure

ASJC

  • Medicine(all)
  • Neuroscience(all)