Priority 3 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: What are the benefits and risks of acute treatments for intracerebral haemorrhage (e.g. surgery and medications)? (JLA PSP Priority 3)
Overall ranking	3
JLA question ID	0106/3a
Explanatory note	Around 1 in 10 strokes are caused by bleeding in the brain - intracerebral haemorrhage (ICH). Intracerebral strokes are more rare, but generally more severe than those caused by a blockage (ischaemic stroke) and are associated with a considerably higher risk of dying. Around a third of patients don’t survive longer than one month, and many remain dependent on others (https://www.stroke.org.uk/research/turning-research-findings-benefit-patients-after-intracerebral-haemorrhage). There is limited evidence for interventions for ICH patients to stop or reduce the damage an ICH causes to the brain [Ref. 3]. This evidence is needed to improve outcomes for these patients. Ref 3: https://www.stroke.org.uk/research/searching-medicines-can-reduce-damage-after-bleed-brain
Evidence	No evidence identified
Health Research Classification System category	Stroke

Extra information provided by this PSP
Original uncertainty examples	In patients with haemorrhagic stroke with a parenchymal haematoma, are there minimally invasive techniques, such as endoscopic aspiration that can improve clinical outcome by preserving brain tissue? ~ What is the potential role of statins for those patients with a previous cerebral haemorrhage; including when after the cerebrovascular event therapy to alter lipid levels should statins be started; at what baseline lipid levels should treatment be commenced; what level of reduction should be aimed for and do the very elderly (those aged over 80 years) stroke patient benefits to the same extent as a younger counterpart?
Submitted by	Health/social care professional x 1, Research recommendation x 1

Extra information provided by this PSP

Original uncertainty examples

In patients with haemorrhagic stroke with a parenchymal haematoma, are there minimally invasive techniques, such as endoscopic aspiration that can improve clinical outcome by preserving brain tissue? ~ What is the potential role of statins for those patients with a previous cerebral haemorrhage; including when after the cerebrovascular event therapy to alter lipid levels should statins be started; at what baseline lipid levels should treatment be commenced; what level of reduction should be aimed for and do the very elderly (those aged over 80 years) stroke patient benefits to the same extent as a younger counterpart?

Submitted by

Health/social care professional x 1, Research recommendation x 1

PSP information
PSP unique ID	0106
PSP name	Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP.	93 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	30th April 2021