What causes hemorrhagic stroke?

Posted on Wed, 29 Apr 2015 in Brain and Spine
Question: For a case of a 2-year old Hemorrhagic Stroke due to a left frontal aneurysm which was clipped, leaving my wife unable to swallow or speak, fed by PEG tube, a week right side and poor cognition. What effective treatment would you recommend to achieve some improvements?
Would Enbrel or Edaravone be promising any positive effect?
Answered by Dr. Olsi Taka 32 minutes later
Brief Answer:
Not promising.

Detailed Answer:
I read your question carefully and I am sorry about your wife's condition. As a neurologist I deal with such situations often and I know how hard it is for the whole family.

Regarding your specific question, I don't know of any use at all of Enbrel for any stroke patient, it is a drug used to treat patients with some autoimmune rheumatological conditions.

As for Edaravone there are some indications about a modest benefit, but it is studied in ischemic not hemorrhagic stroke, even in ischemic stroke its not yet proven, and anyway it's a benefit which has been suggested when it is used in the first 24 hours from the onset of the disease. So I don't see much use in your case.

Generally speaking, there are out there several drugs which claim to help recovery and improve outcome after stroke (cerebrolysine, neuroaid, piracetam, gliatiline etc etc. However non of them has been proven in comparative studies to have any effect, they are not present in expert guidelines, and it is hard to know when their supposed benefit is only a commercial one, trumpeted by pharmaceutical companies. You can try them but I can't recommend them from a sound scientific evidence based point of view. Also most of them are of benefit when used early in the course of the disease. In the particular case of hemorrhage from an aneurysm only Nimodipine started during the first 2 days after the hemorrhage has shown a modest protective benefit on the brain.

Most improvements after stroke happen in the first 3-6 months. After that period, especially after 2 years as in your case, I am afraid not much is expected, I am sorry to have to say that.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 38 minutes later
Regarding the use of Enbrel in post-stroke patients, reported on "60 Minutes" it was is used by two MDs, one in California the other in Florida USA with results beyond expectations. The Enbrel is injected perispinal in the cervical region while the patient is tilted head down at about 45 degrees. This information is accessible on the Net. It's not FDA approved indication in the USA nor in Australia, yet in a situation like ours people are tempted to try anything with the hope to recover a loved one. Besides the Enbrel trials, what is your experience with Hyperbaric Oxygen Therapy?
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below

Detailed Answer:
Thank you for your feedback.

I did an internet research about the Enbrel claims of efficacy in stroke. Honestly I didn't find them convincing at all. First I found nothing in its mechanism of action to suggest how did it improve stroke recovery. It suppresses a factor active in the immune response, which can make sense for its effect in autoimmune rheumatological conditions, but stroke isn't related to immune activity and I don't really see how can it be effective. Also the more claims a drug has the more doubtful I am generally and it seems really miraculous to have all of a sudden a drug which acts in stroke, Alzheimers and other conditions.
The claims about its effect were made by a couple of doctors (internists) with some case reports. Any drug after case reports is investigated by comparing its effect with placebo in similar groups of patients and I didn't see any such study, even though these doctors make such claims since at least 2011 from what I found. So I would really spare the 5000$ I read the injection costs (which would be repeated again in time).

As for hyperbaric oxygen I don't have any personal experience as it is not approved for this indication, so its only application would be in the setting of a trial. However there are small trials, comparing use and non-use, which indicate effect even after a long time from stroke(the longest 36 months). It is not enough to make a recommendation, it is a question of small trials and more is needed, but its use would at least make sense and would be justifiable. So if offered by your healthcare system for that indication it could be tried.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Olsi Taka


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