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Combined blood and brain tests predict repeat stroke risk


    Researchers at Edinburgh University have been using blood tests and CT scans to identify what factors increase the likelihood of individuals suffering a further stroke again in the future, following a specific type of stroke. The study is published in Lancet Neurology and was funded by the Medical Research Council, Stroke Association and Wellcome Trust.

    By David Stafford

A stroke occurs when the blood supply to your brain is interrupted or reduced, depriving your brain of the vital oxygen and nutrients it needs to survive.

There are two main types of stroke, which affect the brain in different ways and can have different causes:

  • Ischaemic stroke – where the arteries to your brain become narrow or blocked, causing severely reduced blood flow.
  • Haemorrhagic (bleeding) stroke – where a blood vessel in your brain leaks or ruptures.

The research being performed at Edinburgh University focuses on the latter, those strokes caused by brain bleeding – known as intracerebral haemorrhage (ICH). ICH accounts for up to 50% of all strokes worldwide.

How intracerebral haemorrhage (ICH) usually occurs

As it currently stands about half of those patients who suffer an ICH die within one year of their first stroke occurring, usually from another bleed.

Haemorrhagic strokes are caused by a build-up of a protein known as amyloid in the walls of blood vessels in the brain. This build-up of amyloid protein leads to a condition known as cerebral amyloid angiopathy (CAA).

The protein deposits in CAA cause the blood vessels in the brain to crack, meaning blood then leaks out and damages the brain. CAA is a common process in ageing and is usually harmless, though amyloid deposits are also found in the brain of those with Alzheimer’s disease. However, most patients with Alzheimer’s disease do not have CAA, which would suggest two different things are happening when comparing strokes to this degenerative disease.

How the new research helps to identify repeat stroke risk

By testing patients who have had a haemorrhagic stroke for the presence of CAA and combining this with CT scanning, a further haemorrhagic stroke could be prevented. The patient’s blood is tested for a gene known as APOE, which is linked to CAA. When combined with a CT scan it allows the researchers to accurately spot if a cerebral bleed has been caused by CAA.

One of the researchers, Dr Mark Rodrigues, when speaking to BBC Health News about this research said the following:

“Identifying the cause of a brain haemorrhage is important to planning patient care… Our findings suggest that the combination of routine CT scanning with APOE gene testing can identify those whose ICH has been caused by CAA – a group who may be more at risk of another ICH or dementia.”

This new approach could revolutionise the way doctors manage patients that are prone to strokes of this nature, as by testing those that have already suffered an ICH this will help them identify those patients who are at a higher risk of suffering an ICH again in the future and they can treat them accordingly.

At present there is no treatment to prevent cerebral amyloid angiopathy; however, research is ongoing in this area.

This research will not only benefit UK patients but also has the potential to be rolled out worldwide as resources develop. And with the news that people are on average having strokes at a younger age, this kind of research is of very real value to people whether they’ve had a stroke or not.

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