Spontaneous intracerebral hemorrhage (ICH)is a major public health problem,involving approximately 31,500 Americans yearly and resulting in more than 15,000 deaths. Approximately one of 10 strokes in an ICH. Benefit has not been established for any specific medical or surgical therapy. In an ongoing study of hyper-acute therapy for cerebral infarction using tissue plasminogen activator, 20 percent of the patients arriving for care within 60 minutes of symptom onset have been excluded because of ICH. Active intracerebral bleeding was documented by the Principal Investigator for two of these patients. For one of thee patients, the active bleeding preceded clinical deterioration. These two cases plus documented active bleeding in three other cases in Cincinnati prompted the investigators to review prior studies regarding the temporal profile of continued bleeding in the setting of spontaneous intracerebral hemorrhage. Unfortunately, this question has not been appropriately addressed. If active bleeding continues for 1-6 hrs following onset of spontaneous intracerebral hemorrhage, there may exist a """"""""therapeutic window"""""""" during which therapeutic maneuvers such as blood pressure adjustment, administration of antifibrinolytic therapy, or ultra-early surgical evaluation may hold promise. We propose performing hyper-acute evaluation of all stroke patients at 7 major Cincinnati hospitals so as to identify patients with ICH. Patients who are examined with computed tomography (CT) within 3 hours of symptom onset will be examined with a standard neurological examination score. The CT scan will then be repeated 3 times -- 60 minutes after the first CT, 6 hours from symptom- onset, and 20 hours from symptom-onset. The standard neurological examination will also be repeated at those times. Data will be gathered on each patient regarding the risk factors for ICH, coagulation and fibrinolytic parameters, and frequent blood pressure measurements. Fifty-two patients will be studied over a 30-month period. Patients who expire will be examined at postmortem to determine the primary diagnosis and to determine, if possible, the reason for hemorrhage growth (if active in-hospital bleeding has been documented prior to death). The primary study objectives are: 1) to determine the percentage of patients with ICH who have CT evidence of continued bleeding during the first hours after onset, and 2) to determine whether CT evidence of continued bleeding correlates with early clinical deterioration.
