Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, June 23, 2024

Treatment for intracerebral hemorrhage: Dawn of a new era

 This is why we need survivors in charge, we wouldn't give up. You better wait a couple of decades before you have your intracerebral hemorrhage stroke

Treatment for intracerebral hemorrhage: Dawn of a new era

Abstract

Intracerebral hemorrhage (ICH) is a devastating disease, causing high rates of death, disability, and suffering across the world. For decades, its treatment has been shrouded by the lack of reliable evidence, and consequently, the presumption that an effective treatment is unlikely to be found. Neutral results arising from several major randomized controlled trials had established a negative spirit within and outside the stroke community. Frustration among researchers and a sense of nihilism in clinicians has created the general perception that patients presenting with ICH have a poor prognosis irrespective of them receiving any form of active management. All this changed in 2023 with the positive results on the primary outcome in randomized controlled trials showing treatment benefits for a hyperacute care bundle approach (INTERACT3), early minimal invasive hematoma evacuation (ENRICH), and use of factor Xa-inhibitor anticoagulation reversal with andexanet alfa (ANNEXa-I). These advances have now been extended in 2024 by confirmation that intensive blood pressure lowering initiated within the first few hours of the onset of symptoms can substantially improve outcome in ICH (INTERACT4) and that decompressive hemicraniectomy is a viable treatment strategy in patients with large deep ICH (SWITCH). This evidence will spearhead a change in the perception of ICH, to revolutionize the care of these patients to ultimately improve their outcomes. We review these and other recent developments in the hyperacute management of ICH. We summarize the results of randomized controlled trials and discuss related original research papers published in this issue of the International Journal of Stroke. These exciting advances demonstrate how we are now at the dawn of a new, exciting, and brighter era of ICH management.

Intracerebral hemorrhage—the deadly sibling of ischemic stroke

Intracerebral hemorrhage (ICH) is caused by the rupture of cerebral vessels which results in bleeding within the brain parenchyma and/or ventricles.1 Overall, ICH comprises approximately 10–15% of all strokes worldwide, but the rates are higher in low- and middle-income countries.2 Compared to ischemic stroke, the incidence of ICH has increased in recent years and the prognosis remains poor.3,4 Current estimates predict a significant increase in the incidence of ICH in Europe related to aging and greater use of anticoagulants, with major implications for health care systems and societies.5

Treatment of ICH before 2023—widespread frustration and nihilism

For decades, treatment of ICH has been overshadowed by limited evidence and a presumed lack of effective treatment options reflected by neutral and restrictive guideline recommendations.6,7 Several randomized controlled trials of surgical treatment (i.e. different approaches to evacuation of parenchymal or intraventricular hematoma),811 blood pressure (BP) control,12,13 and hemostatic therapies,1416 resulted in either borderline significant or neutral results. The evidence was persuasive from INTERACT2,12 and stronger when pooled with other trials as part of an individual patient data meta-analysis,17 for a beneficial effect of early intensive BP lowering. Although a study-level meta-analysis of hematoma evacuation also found a potential benefit,18 there is ongoing uncertainty over which patients have the most to gain from neurosurgery along with the optimal timing and technique of intervention. Collectively, these efforts have contributed to somewhat of a negative spirit within (and outside) the stroke community, and in turn degrees of frustration and nihilism regarding treatment approaches and the perception of a uniformly poor prognosis for patients with ICH.19
 
More at link.

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