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This Cochrane diagnostic test accuracy review looked at the evidence for the radiology test computed tomography angiography (CTA), which demonstrates blood flow in the main vessels of the brain, to support the results of clinical tests of brain function performed in unconscious patients on mechanical breathing machines who are thought by their doctors to have died.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Blood vessel abnormalities are the leading cause of bleeding in the brain (known as intracerebral haemorrhage) in young adults. Early detection of blood vessel abnormalities may improve outcome if treatment can prevent bleeding recurrence. This review looked at different tests used to identify blood vessel abnormalities in the brain. Intra‐arterial digital subtraction angiography (IADSA) is the standard test used and involves positioning a tube, introduced through a blood vessel in the groin, into blood vessels near the brain. Dye is directly injected into the brain's blood vessels using this tube. Computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) are newer tests that may be done without any injections (MRA) or only through an injection into the arm (CTA and MRA). This review investigated the accuracy of CTA or MRA, or both, compared with IADSA after intracerebral haemorrhage. We found eight studies (involving 526 participants) that compared CTA with IADSA and three studies (involving 401 participants) that compared MRA with IADSA. Both CTA and MRA appear to have good accuracy when compared with IADSA. However, the studies were small and were limited in many cases by their design. Further research that looks at accuracy, practicality, and costs is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Subarachnoid haemorrhage (SAH) is a life‐threatening type of stroke caused when a small blood vessel near the surface of the brain bursts. The bleeding usually comes from an aneurysm (a weakness in the blood vessel wall). The blood enters the fluid‐filled space around the brain called the subarachnoid space, which lies between the outer surface of the brain and the inner surface of the skull. Thus, the condition is called aneurysmal SAH. Approximately one‐third of patients develop a complication of the bleeding in which narrowing of the blood vessels occurs. In turn, this may cause the blood supply to parts of the brain to be reduced or stopped. The resulting brain damage is called delayed cerebral ischaemia. It happens most often four to 10 days after SAH, and it can cause disability or even death. In animal studies, the drug tirilazad appeared to reduce brain damage after SAH. We reviewed the evidence from randomised controlled trials of tirilazad in patients with SAH to see if it could reduce the risk of death or disability. The review did not show any evidence of benefit from tirilazad in patients with aneurysmal SAH.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

There is no evidence of benefit from corticosteroids for patients with stroke due to bleeding. About one fifth of all strokes are due to bursting of an artery. The burst artery causes bleeding into the brain itself (called intracerebral haemorrhage) or into the space around the brain (called subarachnoid haemorrhage). After either type of bleed the brain tissue may become swollen. The swelling causes a rise in pressure which can cause further brain damage or even death. Corticosteroids could reduce swelling after brain haemorrhage and so improve the chances of the patient recovering. However, corticosteroids can also have important adverse effects such as increased blood sugars, infection, and gastrointestinal bleeding. The trials included in this review had too few participants to provide reliable evidence on any benefits weighed against harms of this treatment for patients with stroke due to bleeding in the brain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Subarachnoid hemorrhage is an uncommon cause of stroke that often occurs at a young age, producing a relatively large burden of premature mortality. Delayed ischemic neurological deficit (DIND), a condition where the patient's condition deteriorates, has long been recognized as the leading potentially treatable cause of death and disability in patients with subarachnoid hemorrhage. Endothelin is a long‐lasting agent that causes blood vessel constriction, which has been implicated in the cause of DIND. Drugs that reverse this effect (endothelin receptor antagonists, ETAs) have emerged as a promising treatment for subarachnoid hemorrhage. This review of four trials, involving 2024 participants, showed that ETAs reduced the risk of DIND but did not improve clinical outcomes and had potentially serious side effects, such as low blood pressure and chest infection. There is not enough evidence to conclude that ETAs are beneficial in SAH.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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