Associate feature: We’re 50 years behind in treating stroke due to brain haemorrhage

Image: Professor Rustam Al-Shahi Salman

Fifty years ago, people suffering from a heart attack were taken to hospital, given pain relief, and doctors then watched and waited to see whether they would survive. Around 80 per cent didn’t.

Thanks to decades of research, 80 per cent of people now survive a heart attack. If only the same could be said for stroke due to brain haemorrhage - when a blood vessel bursts and bleeds into the brain.

Every ten seconds, someone somewhere in the world has a brain haemorrhage. Within a year, more than half of these people will die.

When blood vessels in the brain rupture, it is very difficult to make the bleeding stop. So far, nine clinical trials looking at drugs to halt bleeding in the brain have not shown a clear benefit for patients.

Analysis from the British Heart Foundation this month has shown us that the number of people dying from a stroke in the UK has remained static for the last five years. This is despite an increase in general awareness of stroke symptoms and a rise in stroke sufferers making it to A&E.

It’s clear that we urgently need more options for patients. There is no specific emergency treatment for brain haemorrhage. The only options at our disposal are lowering blood pressure with drugs or - as a last resort - removing the blood with surgery. But again, several clinical trials have not shown a clear benefit of these treatments for patients.

Why is the situation so dire for stroke patients? Clinical trials looking at treatments for brain haemorrhage are notoriously difficult to conduct. Death rates are high and those who do survive are often left with life-long disabilities, meaning the pool of people we have to recruit from is small.

Clinical trials are also expensive. The total overall research funding by charities and government into stroke is small when compared to the death and disability that it causes - in 2012 the total research spend on stroke was less than half the comparable spend on dementia or cancer. We’re going to need to see more investment into stroke research if we want to change the story for people who’ve had a stroke.

Despite the challenges, it may be that patients provide some of the solutions, and can help us to bring brain haemorrhage treatment into the 21st century.

Since 2010, the LINCHPIN study in Edinburgh has been collecting a bank of brains from people who die after brain haemorrhage. So far, more than 130 people who’ve had a brain haemorrhage have bequeathed their brains to us after their death. We use the brain tissue to understand the causes and consequences of brain haemorrhage. This could help to identify new treatments.

Next, we want to look at the role that inflammation - caused by brain tissue coming into contact with blood during a stroke – may play in helping or hindering recovery. There are many treatments for inflammation, but we don’t know which ones to use after brain haemorrhage. Hopefully, this will lead to clinical trials of a treatment for inflammation that may improve outcome for people with brain haemorrhage.

My research programme at the University of Edinburgh is called RUSH - Research to Understand Stroke due to Haemorrhage. It’s a fitting acronym, because we are quite literally in a rush – a race against time driven by an ageing population who are prone to brain haemorrhage. Until we find a way to treat brain haemorrhage the number of people dying or suffering long-term disability is only going to increase.

Professor Rustam Al-Shahi Salman is Personal Chair of Clinical Neurology at the University of Edinburgh. He leads the Research to Understand Stroke due to Haemorrhage (RUSH) programme