Jatinder Minhas

Jatinder Minhas

3-year Dunhill Medical Trust Research Training Fellowship: Feasibility of Improving Cerebral Autoregulation in Acute Intracerebral Haemorrhage – BREATHE-ICH Study

I am a Clinical Research Fellow in Geriatrics and Stroke Medicine with a research interest in cerebral autoregulation (CA) and acute intracerebral haemorrhage (ICH). I also work in a clinical setting as a Specialist Registrar and am also involved in the recruitment to a range of clinical multi-centre stroke studies. Prior to commencing my Fellowship, I was an NIHR ACF, developing a strong foundation in Transcranial Doppler (ultrasound modality used to assess blood flow), links to a patient participation group of stroke survivors and importantly published and presented pilot data internationally.

Professor Thompson Robinson and Professor Ronney Panerai of the Department of Cardiovascular Sciences, University of Leicester, supervise this research. The departmental research interests relate to the study of cerebral haemodynamics, and in particular the impact of changes in cerebral haemodynamic control mechanisms on the management of blood pressure, blood pressure variability and other physiological perturbations following acute stroke.

Acute ICH has the highest mortality of all stroke subtypes, 40% at 30 days, with half of sufferers dying within a year. Unfortunately, despite being the most devastating form of stroke, it remains the least treatable form with limited therapeutic options.

The ability to maintain an adequate brain blood flow despite sudden changes in blood pressure can be measured in an individual and is referred to as the process of “autoregulation”. This control process has been shown to be impaired in acute ischaemic stroke. Several recent studies have shown impaired CA post-acute ICH. This is particularly important to understand, since our preliminary work has recently shown that changes in carbon dioxide using simple breathing exercises can improve autoregulation. This would imply that should we confirm the impairment of CA in this population and relate this to complications (for example: brain swelling, and haematoma expansion or more bleeding), a novel treatment using a breathing exercise may offer a potential method of improving control of blood flow and importantly prevent complications that cause the significant death rate highlighted above.