ESOC 2018 – Haemorrhagic Stroke

All those working in stroke are all too aware that haemorrhagic stroke can be devastating for patients and their families, yet despite intensive research there remains a relative lack of acute treatments. With the neutral outcome of TICH-2, it is vital that we intensify our efforts to find novel approaches to treating haemorrhagic stroke. Today’s Haemorrhagic Stroke session showcased nine diverse and interesting studies that may lead to patient benefit in the future.

We opened with Dr Parry-Jones from Manchester in the UK describing INFLAME-ICH, a sub-study of the MISTIE III surgical trial. This work demonstrated an intense inflammatory response within the haematoma and will help inform trial of anti-inflammatory agents. Dr Morotti from Pavia, Italy described the BAT score, a simple tool to predict expansion from the plain CT. Talks from Dr Wollenweber and Dr Marti-Fabregas highlighted the importance of cortical superficial siderosis and microbleeds for prediction of subsequent intracerebral haemorrhage. Dr Song from Sydney, Australia, described a score based on acute physiological variables and demonstrated that it predicts outcome. This underpins the INTERACT3 cluster-randomised trial of an acute care bundle targeting rapid physiological control, currently underway in China. The next two talks stayed with the theme of acute physiology, with Dr Law from Nottingham, UK, finding hyperglycaemia to be associated with severe stroke but not worse outcome in the TICH-2 trial and Dr Toyoda presenting further analysis of the ATACH-2 trial of intensive blood pressure lowering. The penultimate talk from Dr You (Suzhou, China) described early and late neurological decline in the INTERACT2 trial. The final talk by Dr Parry-Jones described how introducing a simple ‘ABC’ care bundle was associated with a sustained 33% drop in 30-day case fatality at his hospital and he showed how much of this was down to better supportive care.