Session Report: Intracerebral Haemorrhage I

Dr Kailash Krishnan, MRCP (UK), MRCP (Lond), PhD, FESO

An excellent insight into acute intracerebral haemorrhage at the European Stroke Organisation Conference, Milan and no doubt gratefully received by a large audience this afternoon!

Dr Schreuder demonstrated how ICH as such is not a ‘diagnosis’ and it is critical to investigate causes. Here, the DIAGRAM score could be helpful and the great news for clinicians is that it is readily available on a phone application, Neuromind! Few other pearls were also shared: lobar microbleeds are not always indicative of CAA and rare of causes of ICH are actually not that rare!

Dr Weimar highlighted the bias in studies of prognostic factors after acute intracerebral haemorrhage. His interesting talk showed how research into this devastating stroke has progressed, and now several clinical (including age, GCS, DNAR, neurological deficits, coagulopathy) and radiological parameters (ICH volume, location, IVH, hydrocephalus, spot sign, swirl sign and PHE ) have been shown to be useful prognostic tools. To guide physicians making complex decisions, simple bedside measures using the ICH and similar modified scores can be helpful.

An excellent overview about the mechanisms of perihaematomal oedema formation and various therapeutic targets was highlighted by Dr K. Sheth.  The talk concluded that how high throughput and automated pipelines can be developed to take advantage of increasingly well defined phenotypes. This combined with Dr Werring’s session on how SVD markers help to determine the underlying arteriopathy, define prognosis and assess disease progression made the session even more intuitive.

The session highlighted the latest ESO guideline that in patients with atrial fibrillation who have had an ICH, no recommendation can be made whether anticoagulation should be restarted or not. The quality of evidence at present is low and the strength of the recommendation weak. More research is clearly needed and until then, we clinicians need to actively recruit to the ongoing various trials.