When people talk about a stroke, they are usually referring to ischemic stroke, in which an artery in the brain becomes blocked and affected areas of the brain are subsequently no longer supplied with nutrients and oxygen. Cerebral hemorrhage is another form of this medical emergency, in which a blood vessel bursts. As a result, brain cells are not only damaged by the hemorrhage itself - the resulting pressure can cause additional damage to the brain. A study by scientists at Med Uni Graz around Simon Fandler-Höfler from the University Department of Neurology - has looked at the risk of brain hemorrhage and how imaging using magnetic resonance imaging (MRI) can support the risk assessment of patients.
A question of timing
A common and particularly dangerous form of stroke is intracerebral hemorrhage (or brain hemorrhage), which occurs about 3,000 times a year in Austria and, together with other forms of stroke, is the third leading cause of death. People who have survived such a cerebral hemorrhage generally have an increased risk of suffering another hemorrhage. However, it would often be necessary to take blood-thinning medications (antiplatelet or anticoagulation) for reasons related to other conditions, which can lead to a difficult risk assessment, as these can exacerbate a brain hemorrhage. For this very reason, it is extremely important to assess the individual risk of rebleeding. The research work of Simon Fandler-Höfler from Med Uni Graz, recently published in the renowned journal Neurology, deals with how the recurrence of further brain hemorrhages can be predicted based on MRI images.
Cause of brain hemorrhage
The study analyzed data from 443 patients with brain hemorrhages. Based on the MRI images of the patients, the causes of the hemorrhages were investigated and it was examined which of these diseases pose the greatest risk of causing a new brain hemorrhage. Most of these emergencies are caused by so-called cerebral microangiopathies - a group of diseases that lead to damage of small blood vessels in the brain. Simon Fandler-Höfler comments: Often, a cerebral hemorrhage is simply accepted and its causes are not investigated further. Yet it is precisely the determination of the underlying disease that can provide a great deal of information on prognosis and the risk of recurrent cerebral hemorrhage." The risk of recurrence is particularly high in the case of cerebral amyloid angiopathy, in which chronic processes can lead to damage to the smallest brain vessels and consequent bleeding. But also in the case of other causes, such as the so-called hypertensive cerebral microangiopathy, the individual risk of a new cerebral hemorrhage can be well assessed thanks to modern imaging. The diagnosis of these diseases is usually made by MRI of the brain - although in a second, separate research study it was possible to show which diagnostic criteria of cerebral amyloid angiopathy are particularly relevant for the risk of a new cerebral hemorrhage.
The study has shown that MRI can provide a good estimate of the risk of recurrent brain hemorrhage - depending on the combination of cause and MRI changes, this risk can range from 61% to less than 1 over five years. Patients* with so-called cryptogenic cerebral hemorrhages, in whom no cause could be identified despite extensive investigation, had an extremely low risk of recurrent cerebral hemorrhage. These examination results are not only important for the treatment, but also for the prognosis for the patient, his/her family and caregivers. The individual assessment of the risk can be done by MRI and, in addition to the immediate importance for the patient, often has direct implications for decisions in drug therapy," says Simon Fandler-Höfler.
Profile: Simon Fandler-Höfler
Simon Fandler-Höfler is a neurologist with a clinical focus on neurological emergency and intensive care medicine. Scientifically, he is primarily concerned with strokes, especially intracerebral hemorrhage (brain hemorrhage).