Melanie Cole, MS (Host): Welcome to AHN MedTalks, an informative resource for physicians across various specialties, as we delve into the latest medical insights and best practices, ensuring you stay at the forefront of your field. I'm Melanie Cole, and joining me today to highlight hemorrhagic stroke, is Dr. Richard Williamson.

He's a Neurosurgeon with the Allegheny Health Network. Dr. Williamson, thank you so much for being with us. As we get into this topic, I'd like you to speak just a little bit about the difference in how common the prevalence, what you're seeing in the trends as far as hemorrhagic stroke and how it differs from ischemic.

Richard Williamson, MD: Yeah, absolutely. Hemorrhagic stroke, you know, relatively is actually much less common than ischemic stroke. It actually only accounts for about 10 to 20 percent of all strokes. However, it disproportionately accounts for a large number of patients that are dead or disabled after they suffered a stroke.

And so the ICH or the intracranial hemorrhage or hemorrhagic stroke fatality rate is about 25 to 30 percent, which is actually much higher than what we see in ischemic stroke. About the incidence of hemorrhagic stroke in our country is about 12 to 15 cases per 1 million patient years.

So it's relatively uncommon, but unfortunately when it happens, it tends to be very severe.

Host: Those are some sobering statistics anyway. And so as we're talking about this, does the chain of events favoring better functional outcome from hemorrhagic stroke begin with the recognition of that stroke when it occurs? Tell us a little bit about the data that shows that public knowledge of stroke warning signs and really pre-hospital management, field treatment, what's going on in the field right now that you feel favors a better functional outcome.

Richard Williamson, MD: So probably the most important thing, is you know, first and foremost, just educating our patients and our population about the signs and symptoms of stroke so that they can approach and activate medical care in a timely manner. A lot of times those symptoms are very similar to the same symptoms that we see with ischemic stroke where a patient will have, you know, sudden onset of a severe neurologic deficit, hemiplegia, weakness on one side of their body, numbness, but it can also be even things that are more severe with, you know, severe headache, nausea, vomiting, even rapidly going into a coma or unresponsive.

 And obviously, you know, when these things happen, most people in the community they recognize that there's something happening that they need to activate medical care right away, but sometimes the symptoms can be somewhat subtle. And so if there's any concern of stroke like symptoms, the most important thing is to get that patient to a stroke available or stroke ready center as soon as possible.

And we recommend obviously, calling 9-1-1 and activating EMS to get them to a primary stroke center that, so that they can be triaged appropriately. Most patients with hemorrhagic stroke ultimately get sent to a comprehensive stroke center where we have a wide range of specialties that specialize in the complex management of these patients.

Host: Well then speak about that organized protocol and stroke team that speed that clinical assessment and the performance of your diagnostic studies, decision for early management. Explain what happens once they do get to a designated stroke center.

Richard Williamson, MD: So, you know, what we in our stroke program, the metric that we use is the time that it takes for a patient to get from the field to the ER and into the CT scanner. A CT scan of the brain is the most important diagnostic tool that we use to help triage these patients. It also is the initial and the test of choice so we can help delineate patients that are suffering from an ischemic stroke or hemorrhagic stroke because the CT is definitely the best way to evaluate for hemorrhagic stroke. Once that patient gets to the ER and they get that CT, which demonstrates a hemorrhagic stroke, typically we activate the next chain in command. And in most cases that's quickly and safely transporting that patient to a comprehensive stroke center for further care.

Host: Tell us about some of those latest advancements in techniques and treatment that you're using today. What's exciting you, Dr. Williamson?

Richard Williamson, MD: Well, for the longest time, hemorrhagic stroke has been a little bit of a black box from neurosurgical care. And that's because, you know, what we've seen is these patients, they suffer severe strokes, they have significant disability, and up until recently, we've been somewhat limited on how we can take care of these patients.

We can treat their blood pressure. We can, you know, if they're on blood thinners, we can reverse those agents. We can manage some of the symptoms from having a stroke, but a lot of times we couldn't intervene and actually change the outcome. But actually within the last year, a study that AHN actually participated in, looked at a minimally invasive way of removing surgically, certain types of hemorrhagic strokes in the brain. And we actually demonstrated that if we can do this quickly and safely, that those patients are much more likely to return to a normal level of function compared to our usual way which, which we did more supportive care. And so this has been a huge event in the care of these hemorrhagic stroke patients.

Host: What an exciting time in your field. And what about stroke therapy, and after. Tell us a little bit about what's going on there and some of the procedures, whether it's diagnostic capabilities or advancements in imaging, vascular imaging, or procedures. What's exciting?

Richard Williamson, MD: So the most exciting, I mean, one, everything is exciting. This is really a great time for being a part and at the forefront of stroke care; because hemorrhagic stroke, because of its complexity, you know, really touches on all those things that you mentioned. We can rapidly, using AI, identify patients with hemorrhagic stroke.

And so we actually have programs, which a CT scan is obtained in one of our satellite hospitals. Our AI algorithm actually can recognize that there's a hemorrhage on the CT and it can send me a real time alert saying, ey, this patient is having, you know, an intracranial hemorrhage at this facility. And that helps facilitate, ultimately timely transfer to get the patient, to my care.

So that they can be treated quickly and appropriately. Once they're there, again, we have new techniques, minimally invasive techniques, so that we can very carefully and safely remove these hemorrhages with a surgical procedure. And we actually can do, essentially using, almost like a small tube, we can remove the hemorrhage, with a very small incision.

And, makes the patient much more likely to return to a normal level of function once they've recovered. Now, the recovery process is long. I mean, you know, unfortunately, this is still a complex disease. The brain is a complex organ. And so these patients ultimately require a fairly long recovery process, which involves a lot of different resources.

Typically physical therapy, occupational therapy, speech therapy, and can have prolonged stays in acute rehab centers, and even afterwards. But again, the most important part is getting them into the appropriate level of care as quickly as possible.

Host: Before we wrap up, what would you like other providers to know about designated stroke programs like AHN and why it's so important to find that kind of center, when to refer, and anything else you'd like the key takeaways to be?

Richard Williamson, MD: I think that the most important point for all providers is to recognize is that, when you are sending a patient or you have a patient that goes to a comprehensive stroke center like AHN, we hold ourselves to a very high standard. We report all of our data. We're constantly measuring ourselves against every other comprehensive stroke center across the country.

And so as a whole, every center, you know, we're all striving to have the best possible outcomes for our patient. And so, by holding ourselves to that high standard, measuring those metrics, you know, we are translating that to better patient outcomes. And so I think providers can rest assured that getting their patients to a comprehensive stroke center is going to ultimately give that patient the best possible chance of returning to a normal level of function.

Host: It certainly will. And thank you, Dr. Williamson, for joining us. Such an informative episode and for sharing your expertise. Thank you again. And to learn more or to refer a patient, please call 844-MD REFER or visit ahn.org. Thank you so much for listening to this edition of AHN MedTalks with the Allegheny Health Network.

Please remember to subscribe, rate, and review this podcast and all the other AHN MedTalks podcasts on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.