Hypertension and cognitive screening and management for preventing haemorrhagic stroke in high-risk groups

Project Outline:

Intracerebral haemorrhage (ICH) or haemorrhagic stroke is defined as bleeding within the brain parenchyma and occurs without trauma or known bleeding causes such as an arteriovenous malformation, cerebral aneurysm, or tumour. ICH accounts for at least 10-15% of all strokes and is even higher pending ethnicity and global distribution. The overall incidence of ICH is reported to range between 15 to 40 cases per 100,000 and may be higher in Asian populations and in individuals over 75 years. ICH can be classified by its location and is referred to as lobar (15%-30%), deep (35%-70%) and infratentorial (10%-20%). Lobar ICH involves haemorrhages located in cortical-subcortical areas and deep ICH being located within the basal ganglia and internal capsule. Infratentorial ICH is sometimes classified under deep ICH and involves the brainstem and cerebellum. Regarding aetiology, lobar ICH, is caused by several distinct diseases with cerebral amyloid angiopathy (CAA) being the most common and refers to abnormal aggregations of beta amyloid deposits that form in the walls of cerebral arteries, arterioles and capillaries and is considered responsible for increasing bleeding risk and cognitive impairment. The most frequent cause of deep ICH is deep perforating vasculopathy with hypertension being the most important risk factor. With the highest proportion of haemorrhagic strokes caused by undetected hypertension and mild cognitive impairment, there is a dire need for a hypertension and cognition screening protocol to be rolled out in regions where ethnic minority groups are predisposed to the greatest risk of sustaining haemorrhagic stroke. The aim of this research is to develop greater awareness for blood pressure and cognitive screening among health professionals and to monitor at risk groups for haemorrhagic stroke in addition to ischaemic stroke.

For further reading, see

Donnellan, C., Werring, D. Cognitive impairment before and after intracerebral haemorrhage: a systematic review. Neurol Sci 41, 509–527 (2020). https://doi.org/10.1007/s10072-019-04150-5

Project Area: Stroke and associated cerebrovascular disease

Supervisor(s): Professor Claire Donnellan

Project level: PhD

Start date: Ongoing