Grant: Operating Grant

This study tackles the problem of intracerebral hemorrhage, a serious type of stroke caused by bleeding into the brain from a ruptured blood vessel. It accounts for 10-30% of all strokes worldwide, often affecting young people, and is the deadliest, most disabling, and least treatable stroke type. Sadly, there are no proven emergency medical treatments available. We urgently need to develop an effective therapy and identify which patients will benefit most from treatment. The ideal treatment is one that can act quickly to stop bleeding and prevent hemorrhages from enlarging to a critical, life-threatening size. Now, an exciting treatment called "Factor 7", which has been used for years for other bleeding disorders, holds great promise for treating brain hemorrhages. Recently, "Factor 7" was shown to reduce the amount of bleeding in the brain by 58%! However, this did not translate into improved survival or reduced disability when given to a group of unselected patients. We believe this treatment will work best when given to a specific subgroup of brain hemorrhage patients that we call the "spot sign" patients. This study will test whether treatment in the emergency room with "Factor 7" is beneficial for brain hemorrhage patients who have a "spot sign" on brain scanning. A "spot sign" is detected by a contrast CT scan of the blood vessels in the head. Our group described this sign in 2007 as a bright dot within a hemorrhage, corresponding to leakage of contrast dye (extravasation) from a bleeding blood vessel. If a "spot sign" is present, it predicts a very high risk of worsening due to continued bleeding in the brain. About one-third of patients have a "spot sign" (indicating active bleeding) and two-thirds do not have a "spot sign" (indicating the bleeding has already stopped). Therefore, this sign should predict which patients will respond best to "Factor 7" therapy. If proven correct, this approach could revolutionize the management of hemorrhagic stroke.