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Hugh Markus - 2011 Merrill P. Spencer Lecturer

Each spring, The Merrill P. Spencer, M.D. Endowed Lecture is presented in conjunction with the annual Swedish Neuroscience Institute Cerebrovascular Symposium. This year, we are pleased to welcome Dr. Hugh Markus, Professor of Neurology at St. George’s University of London.

Hugh Markus was educated in Medicine at Cambridge and Oxford Universities and then carried out medical jobs in Oxford, London and Nottingham before training in neurology in London. He was senior lecturer and subsequently, reader in neurology at Kings College London before moving to the chair of neurology at St George’s in 2000.

His clinical interests are in stroke, and he is clinical lead for stroke at St George’s Hospital. He is involved in both acute stroke care and outpatient stroke clinics, and runs specialist services for patients with sub cortical vascular disease and genetic forms of stroke.

Multiple Sclerosis Center 2nd Annual Art Show 2011

The Multiple Sclerosis Center at Swedish Neuroscience Institute is hosting its Second Annual Multiple Sclerosis Center Art Show at the Bellevue Arts Museum on Saturday and Sunday, June 18 & 19, 2011 from 11:00am to 5:00pm. There will be an ‘Artist Only Meet ‘n’ Greet, Sunday June 19th from 3pm – 5pm

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Advances in thrombolysis

 Washington State has one of the high est stroke mortality rates in the nation. To improve this situation, acute intervention al therapies for stroke are being employed to restore circulation to ischemic brain tissue that surrounds areas of completed infraction, while avoiding risk of hemor rhage due to reperfusion of large areas of infracted brain tissue.

Urgent thrombolysis with intrave nous alteplase is the only therapy known to improve clinical outcomes following acute stroke. Unfortunately, alteplase has had limited usage because many patients arrive in an emergency department after the three-hour treatment window. The FDA has also approved two clot removal devices based on the ability to restore circulation. These devices are used up to eight hours after symptom onset. Several approaches to improved acute stroke care are now under way, including extension of the thrombolysis window to 4.5 hours, identification of safer thrombolytic agents and research identifying brain at risk of in farction following a stroke.

A recent European study demonstrat ed the efficacy of alteplase up to 4.5 hours after ischemic stroke in patients younger than age 80 years who have neither dia betes mellitus or prior stroke. The safety profile during this longer window for these patients appears similar to that at three hours.

Another promising advance employs a new thrombolytic agent called des moteplase.

Detecting cerebral microemboli with transcranial doppler

Since its introduction in 1982, transcranial doppler ultrasound (TCD) has evolved into a por­table, multimodality, noninvasive method for real-time imaging of intracranial vasculature.

The detection of cerebral microemboli is among the more remarkable capabilities of TCD. Emboli create countable signals in the ultrasound display due to the higher reflection of sound waves compared to the blood cells. Experimental mod­els have shown a high sensitivity and specificity for detection of a variety of substrates, including thrombotic, platelet and atheromatous emboli.

Microembolic signals (MES) within the in­tracranial vasculature are most frequently identi­fied in patients with large-vessel atherosclerotic disease, such as carotid stenosis. They have also been reported in intracranial arterial stenosis, ar­terial dissection, cardiac disease and atheroaortic plaque. Additionally, they have been seen in arter­ies distal to coiled aneurysms.

There is strong evidence that MES detection predicts future ipsilateral stroke risk in patients with symptomatic carotid stenosis (Markus HS, et al.; King A, et al.). A recent study of patients with asymptomatic carotid stenosis demonstrated that MES predicted subsequent ipsilateral stroke and TIA, and also ipsilateral stroke alone, and that it is helpful in selecting patients who will benefit from carotid endarterectomy (Markus, HS et al.).

Identification of active embolization provides crucial patho­physiological information to the neurologist and can also aid in the selection of tailored therapy aimed at reducing the risk of stroke. Emboli from different sources have unique compositions and re­quire specific therapy, such as antiplatelet agents for emboli from large artery atherosclerotic plaque and anticoagulants for cardiac emboli.

Future advances in TCD technology will permit full automa­tion and better identification of the composition and size of circu­lating embolic materials, thus improving its value for patients with cerebrovascular disease.

Contact Colleen Douville, RVT, at colleen.douville@swedish.org or 206-320-4080, for more information about TCD for detec­tion of cerebral microemboli.

Options widening for wide-necked aneurysms

Intracranial aneurysms are present in up to 4 percent of the population. These potentially dangerous vascular lesions are being detected with increasing frequency in asymptomatic patients by advances in noninvasive imaging techniques, such as magnetic resonance angiography (MRA). Appearing like blisters on the wall of the brain’s blood vessels, aneurysms develop when the blood vessel’s native repair ability is exceeded by the mild, but constant, injury created by flowing blood under high pressure. The five most common risk factors for developing an aneurysm are: smoking, female gender, high blood pressure, middle age and family history.

Intracranial aneurysms are complex lesions that require a highly specialized, multidisciplinary approach that is individualized for each patient. Key members of the care team for these patients include endovascular neuroradiologists, neurosurgeons with special expertise in aneurysm surgery and neuroanesthesiologists. Availability of dedicated neurocritical care units is an essential care component. A consensus recommendation by these specialists may include close observation, obliteration of the aneurysm with a surgical clip, or filling the vascular outpouching with filamentous coils that are introduced by endovascular microcatheters via an artery in the leg. This latter process is called “coiling.”

Multimodal Treatment of Spinal Tumors symposium

Join us next week!
Multimodal Treatment of Spinal Tumors symposium
Friday, February 25, 2011

Course Chair: Rod J. Oskouian, Jr., M.D, Neurosurgery, Spine Surgery, Swedish Neuroscience Institute.

Today, health-care providers who treat patients with spinal tumors are able to offer a myriad of treatment options that were essentially non-existent in the recent past. Internationally renowned speaker, inventor, entrepreneur and neurosurgeon, John R. Alder, M.D., will present the keynote presentation at this year's symposium and initiate our discussion of the technical and therapeutic options available for spinal tumor patients.

For full course information and to register: http//www.swedish.org/spinaltumors2011

Pediatric Neuroscience Center receives “Tuberous Sclerosis Complex (TSC) Clinic” Designation

The Tuberous Sclerosis Alliance announced today that it has designated the Swedish Pediatric Neuroscience Center (SPNC) at SNI as a TSC Clinic. Marcio Sotero, MD, medical director of SPNC, is the director of the new center. This designation is an important step forward in the regional delivery of care to patients with tuberous sclerosis, as the TSC Clinics closest to Seattle are located at the Barrow Neurological Institute in Phoenix and Children’s Hospital in Oakland, CA.

TSC is a genetic disorder that causes tumors to form in many different organs, primarily in the brain, eyes, heart, kidney, skin and lungs. Seizures are a very common manifestation, and some people with TSC experience developmental delay, mental retardation and autism.

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