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intracerebral hemorrhage

Pregnancy and Cervical Artery Dissection: Risk Assessment

by Dr. Michael Lee – Health Editor July 31, 2025

written by Dr. Michael Lee – Health Editor

Pregnancy Safe for Women with Prior cervical Artery Dissection, Study Finds

New research offers reassuring news for women with a history of cervical artery dissection (CeAD), indicating that pregnancy does not elevate the risk of recurrent cead, stroke, or death.

Basel, Switzerland – For women who have experienced cervical artery dissection (CeAD), the prospect of future pregnancy may no longer be a cause for significant concern. A groundbreaking cohort study, published in JAMA Network Open, reveals that pregnancy is not associated with an increased risk of recurrent CeAD, stroke, or death up to five years later.

The study, led by Sandro K. Fischer of the University Hospital Basel, analyzed data from 1013 women with a history of CeAD across 33 stroke centers in nine countries, with follow-up data extending from 1990 to 2023. Of these women, 114 became pregnant during the study period, while 899 did not.

Researchers tracked a composite outcome of recurrent CeAD, any type of stroke, and all-cause mortality. The findings demonstrated that the composite outcome occurred in 9% of the pregnancy group, compared to 7% in the non-pregnancy group. Crucially, the adjusted hazard ratio (aHR) for this composite outcome was 0.77 (95% CI, 0.38-1.56), indicating no statistically significant increase in risk for pregnant women.

Further analysis of secondary outcomes also showed no significant differences between the groups for recurrent CeAD (aHR,1.0), ischemic stroke (aHR, 0.5), and intracerebral hemorrhage (ICH) (aHR, 1.0). The incidence rate of recurrent CeAD was 0.7% per patient-year in the pregnancy group versus 0.5% per patient-year in the non-pregnancy group.

Interestingly, five of the ten primary outcome events in the pregnancy group occurred during the postpartum period, suggesting a potential heightened vulnerability during this specific phase.

“These findings suggest that pregnancy is not associated with an increased risk of subsequent events; therefore, prior CeAD does not justify advising against future pregnancy,” the investigators stated. They added that these results “may be helpful for individual counseling and family planning for women with prior CeAD.”

While the study offers significant reassurance,its exploratory nature,potential referral bias,and the underrepresentation of women at higher presumed recurrence risk in the pregnancy group are noted limitations. The small number of events also contributed to statistical imprecision.

Despite these limitations, the study’s findings provide valuable insights for clinicians and patients, potentially alleviating anxieties surrounding pregnancy for women with a history of CeAD and supporting informed family planning decisions.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

July 31, 2025 0 comments

Health

New initiative aims to improve surgical care for hemorrhagic stroke

by Dr. Michael Lee – Health Editor July 16, 2025

written by Dr. Michael Lee – Health Editor

Stroke Initiative Targets Deadliest Brain Bleeds

AHA Champions New Surgical Standards for Hemorrhagic Strokes

Hemorrhagic strokes, though less common, are significantly more fatal than ischemic strokes. The American Heart Association is launching a major effort to standardize and advance surgical treatments for these devastating brain bleeds.

New Initiative Aims to Save Lives

Despite accounting for only 13% of strokes in the U.S., hemorrhagic strokes are responsible for over 40% of stroke-related deaths. Historically, a lack of consistent surgical protocols has hampered patient recovery. To combat this, the AHA is spearheading a nationwide initiative to promote effective surgical care, including minimally invasive techniques.

Minimally Invasive Surgery Shows Promise

Financially supported by Stryker, the Hemorrhagic Stroke Surgical Quality Improvement Initiative will highlight successful treatment models, such as minimally invasive parafascicular surgery (MIPS). This advanced procedure utilizes a specialized retractor to navigate brain tissue, allowing for clot removal with reduced potential for damage. Studies indicate that MIPS, when performed within 24 hours of a brain bleed, can lead to superior recovery outcomes at six months compared to traditional methods.

“The ability to share data and accelerate learning is critical to improving stroke care. Through this initiative, we hope to reduce the devastating outcomes associated with hemorrhagic stroke by improving access to surgical interventions proven to improve patient recovery.”

—Kevin Sheth, M.D., FAHA, American Heart Association volunteer, chair of the Association’s ICH Science Advisory Group and director of the Yale Center for Brain & Mind Health

Leading Hospitals Join Collaborative Effort

Fifteen hospitals across the United States will participate in a learning collaborative. These institutions will leverage data from the AHA’s Get With The Guidelines® – Stroke registry, which covers a substantial portion of the nation’s stroke hospitalizations. The selected sites will analyze patient care data and clinical workflows to pinpoint effective models that can be implemented nationwide.

Aurora St. Luke’s Medical Center in Milwaukee
Cleveland Clinic in Cleveland
DMC Detroit Receiving Hospital in Detroit
Eden Medical Center in Castro Valley, California
Hackensack Meridian Health Jersey Shore University Medical Center in Neptune, New Jersey
Indiana University Health Methodist Hospital in Indianapolis
Massachusetts General Hospital in Boston
Memorial Hermann-Texas Medical Center in Houston
Montefiore Medical Center-Moses Campus in Bronx, New York
Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania
SSM Health Saint Louis University Hospital in St. Louis
The University of Kansas Health System in Kansas City, Kansas
UCI Medical Center in Orange, California
University Medical Center of El Paso in El Paso, Texas
Yale-New Haven Hospital in New Haven, Connecticut

Hospitals were chosen based on demonstrated leadership in MIPS, readiness of their infrastructure, and a clear interest in expanding surgical options for intracerebral hemorrhage patients.

In 2023, approximately 934,000 people experienced a stroke in the U.S., with hemorrhagic strokes posing a particularly grim prognosis (Centers for Disease Control and Prevention).

The collaborative’s focus on data sharing and standardized best practices is expected to significantly improve outcomes for individuals suffering from brain bleeds.

July 16, 2025 0 comments

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Hemorrhagic Stroke: Don’t Ignore the Headache | News

by Dr. Michael Lee – Health Editor July 1, 2025

written by Dr. Michael Lee – Health Editor

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Post-Hemorrhagic Stroke Headaches: A Neglected Aspect of Recovery

Table of Contents

Post-Hemorrhagic Stroke Headaches: A Neglected Aspect of Recovery

MINNEAPOLIS-New research reveals that nearly half of hemorrhagic stroke patients experience headaches, with over a third reporting severe pain, highlighting a critical yet often neglected area of post-stroke care. Despite the prevalence of post-stroke headaches, notably following hemorrhagic stroke, management strategies remain underdeveloped, according to Bradley Ong, MD, a neurology resident at the Cleveland Clinic, who presented the findings at the American Headache Society (AHS) Annual Meeting 2025.

The Overlooked Reality of Post-Stroke Headaches

While stroke research heavily focuses on immediate interventions like stopping bleeding and reducing disability, the long-term impact of post-stroke headaches remains understudied. A systematic review and meta-analysis, encompassing 24 studies through December 2024, sought to bridge this knowledge gap. The analysis, which included data from 4,671 hemorrhagic stroke patients, revealed that 47% developed headaches, with 56% experiencing acute or subacute headaches within 30 days and 39% developing chronic headaches lasting over three months.

Did You Know? Post-stroke headaches can persist for months or even years after the initial stroke event.

Types and Severity of Post-Stroke Headaches

The study further distinguished between headache types based on the nature of the hemorrhagic stroke. Patients who experienced a subarachnoid hemorrhage (SAH) frequently enough reported migraine-like headaches, while those with intracerebral hemorrhage (ICH) typically described tension-type headaches, ranging from moderate to severe.Notably, nearly 38% of patients with post-stroke headaches progressed to the chronic phase, underscoring the need for long-term management strategies.

headache Type	Stroke Type	Prevalence
Acute/Subacute (within 30 days)	Hemorrhagic Stroke	56%
Chronic (over 3 months)	Hemorrhagic Stroke	39%
migrainous	Subarachnoid Hemorrhage (SAH)	Most Common
Tension-Type	Intracerebral Hemorrhage (ICH)	Most Common

Factors Influencing Post-Stroke Headache Risk

Several factors can influence the likelihood of developing post-stroke headaches. According to the research, males had lower odds of developing headaches (pooled odds ratio [OR], 0.82; 95% CI, 0.68-0.99), while a prior history of headaches significantly increased the risk (pooled OR, 4.83; 95% CI, 2.10-11.10). These findings emphasize the importance of considering individual patient history when assessing and managing post-stroke headache risk.

The need for Improved Clinical Guidance and Research

Experts emphasize the urgent need for more prospective studies to better understand and address post-stroke headaches. Dr. Ong notes that common over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) are often unsuitable for patients who have experienced a brain bleed, further complicating treatment.Robert G.Kaniecki, MD, founder and director of the UPMC Headache Center in Pittsburgh, also highlighted the study’s strengths in focusing specifically on hemorrhagic stroke patients, noting that previous research frequently enough combined hemorrhagic and ischemic stroke cases.

Pro Tip: Clinicians should proactively include headache treatment as an integral part of stroke rehabilitation programs.

The lack of standardized definitions for post-stroke headache also poses a challenge to research and treatment efforts. More consistent data from diverse populations are needed to gain a complete understanding of the condition and develop effective treatments. Furthermore, understanding the relationship between post-stroke depression and headache progress warrants further inquiry, as headache is a frequent symptom reported by patients with depression.

Addressing the Knowledge Gap in Post-Stroke Headache Management

The findings underscore the necessity for increased awareness and improved management of post-stroke headaches, particularly following hemorrhagic stroke. By recognizing the prevalence, characteristics, and risk factors associated with these headaches, clinicians can provide more comprehensive and effective care to stroke survivors. Further research and the development of standardized treatment guidelines are crucial steps toward addressing this often-overlooked aspect of stroke recovery.

Persistent headache after stroke is a common issue, with up to 23% of patients affected [1]. These headaches frequently enough have tension-type features and can be more frequent and severe than acute stroke-related headaches.

Why do you think post-stroke headaches are often overlooked in clinical settings? what strategies can be implemented to prioritize headache management in stroke rehabilitation?

Understanding Stroke and Headache

A stroke occurs when blood supply to the brain is interrupted, leading to brain cell damage.There are two main types of stroke: ischemic (caused by a blood clot) and hemorrhagic (caused by bleeding in the brain). Headaches can occur as a symptom of the stroke itself or develop as a post-stroke complication. The mechanisms behind post-stroke headaches are not fully understood, but they may involve changes in brain structure, inflammation, or nerve damage.

The Broader Context of Headache disorders

Headache disorders are a significant public health concern, affecting millions of people worldwide. Migraine and tension-type headaches are the most common types, but headaches can also be caused by a variety of other factors, including stress, dehydration, and certain medical conditions. Understanding the different types of headaches and their potential causes is essential for effective diagnosis and treatment.

Frequently Asked Questions About Post-Stroke Headaches

What is a post-stroke headache?

July 1, 2025 0 comments

Health

Early, Aggressive BP Lowering Tied to Better ICH Outcomes

by Dr. Michael Lee – Health Editor June 19, 2025

written by Dr. Michael Lee – Health Editor

Aggressive Blood Pressure Control Improves Stroke Outcomes

Early Intervention is Key for Better Recovery and Reduced Risks

New research reveals that swiftly lowering blood pressure after an intracerebral hemorrhage (ICH) can significantly improve patient outcomes, potentially saving lives. Prompt treatment, especially within the first few hours, leads to better neurological function, fewer adverse events, and reduced mortality rates for those suffering from this type of stroke.

Early Treatment Yields Stronger Results

A pooled analysis of four Intensive BP Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1-4) has confirmed the benefits of early, intensive blood pressure management for individuals experiencing ICH. The most positive results were found when the intervention was administered within three hours of the onset of ICH symptoms. Current guidelines suggest a systolic BP target of less than 180 mm Hg within one hour of symptom onset, whereas the intensive treatment approach aims for less than 140 mm Hg within the same timeframe.

The studies involved over 10,000 adults with acute ICH. Participants were randomly assigned to receive either intensive or guideline-recommended BP-lowering treatment within an hour of symptom onset. The primary outcome measure was functional recovery, determined using the modified Rankin scale. The intensive treatment group showed significantly lower mean systolic BP rates at one hour compared to the guideline group, 149.6 mm Hg versus 158.8 mm Hg, respectively.

“The data presented make a compelling case for ultra-early intensive blood pressure reduction as a potentially useful intervention to improve outcomes in people with acute ICH.”

—David J. Werring, PhD, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London

Those receiving intensive treatment also experienced reduced odds of neurological deterioration within seven days, along with fewer serious adverse events and deaths. According to the American Stroke Association, stroke is a leading cause of death in the United States, with nearly 800,000 strokes occurring annually (American Stroke Association).

Timing and Impact on Hematoma Growth

Investigators also assessed the impact of treatment timing and its effect on hematoma volume. Results from a CT substudy of almost 3000 participants revealed no significant effect on either relative or absolute hematoma growth in the initial 24 hours between intensive and guideline treatment approaches. However, when intensive BP lowering began within three hours of symptom onset, functional recovery improved, and hematoma growth was reduced in almost a quarter of patients.

Expert Insights

In an accompanying editorial, David J. Werring noted the importance of considering the specific pathophysiology of ICH, where hematoma expansion plays a major role in the first few hours. He suggested that intensive BP lowering could be a useful intervention to improve outcomes for individuals with acute ICH, emphasizing the need for further research.

The analysis was funded by a multitude of organizations worldwide, and the investigators disclosed various financial relationships. Despite the limitations of the study, the results underscore the critical importance of early intervention in managing ICH. More research is warranted, but the current findings strongly support the idea that, as Werring concluded, “time is brain” for those with ICH.

June 19, 2025 0 comments