Strokes are common – every year about 125,000 people in England alone suffer a stroke.
About one in eight of these will have an intracerebral haemorrhage, a devastating bleed into the brain which kills about 40 per cent of those affected within a month and leaves most survivors with long-term disabilities.
While treatment for other types of stroke has made huge progress in the last 20 years, outcomes for patients with intracerebral haemorrhage has lagged badly behind.Treatment is limited and nearly 20 per cent have palliative care begun within three days of admission.
Research is helping to change that though – and Salford is among the areas at the forefront of pioneering work to offer fresh hope to the people affected.
Salford Royal’s status as a Comprehensive Stroke Centre, the strong relationships between its stroke and neurosurgery teams and its close work with scientists at The University of Manchester mean that some of the most exciting research in intracerebral haemorrhage – and other types of stroke – can be offered to patients here.
Dr Adrian Parry-Jones is a National Institute of Health Research (NIHR) Clinician Scientist and Honorary Consultant Neurologist with a special interest in intracerebral haemorrhage.
He explained: “We already know that care on an acute stroke unit – like we have here in Salford – improves outcomes for patients and that lowering blood pressure within six hours of the onset of an intracerebral haemorrhage also improves recovery. I am leading a quality improvement project to develop an acute care bundle for stroke patients, which we hope will ensure every patient gets proven treatments as quickly as possible.”
Dr Parry-Jones is also undertaking research to develop new treatments for the future. He added: “My research is particularly concerned with the role of inflammation after bleeding into the brain and whether blocking this inflammation might be beneficial. Over the next five years I will be leading three studies as part of my NIHR award, INFLAME-ICH looking at markers of inflammation in brain fluid after haemorrhage, another using PET and MR imaging to measure blood-brain barrier permeability and brain inflammation, and a third, proof-of-concept study into an anti-inflammatory drug called interleukin-1 receptor antagonist.”
INFLAME-ICH has been incorporated as a sub-study in the groundbreaking worldwide study MISTIE III, for which Salford Royal was the leading recruiter in 2015. The MISTIE researchers, led by Professor Dan Hanley of Johns Hopkins University in the US, have developed an innovative approach to remove blood from the brain after intracerebral haemorrhage. Using computer guidance, the neurosurgeon places a catheter directly into the blood clot through a small hole in the skull. Small doses of a clot-busting drug are injected every eight hours directly into the clot through the catheter, allowing any remaining blood to be slowly removed.
Dr Parry-Jones has also used existing local, national and international stroke data to answer important questions about intracerebral haemorrhage, including how best to reverse blood thinning drugs and describing current practice around starting palliative care. He and his colleague Dr Craig Smith are furthering this work by taking part in the MNEMONICH (Multi-National survey on Epidemiology, Morbidity and Outcomes iN Intracerebral Haemorrhage) initiative, a global collaboration to set up a comprehensive registry of data for future research.