David Newell, M.D., neurosurgeon and co-executive director of the Swedish Neuroscience Institute (SNI), co-authored the cover article in the September Journal of Neurosurgery on the results of a study using ultrasound for the treatment of brain hemorrhage. The study involved 33 patients with spontaneous intracerebral hemorrhage who were screened for inclusion in a SNI clinical study known as “SLEUTH” (Safety of Lysis with Ultrasound in the Treatment of Intracerebral and Intraventricular Hemorrhage). Read the abstract and full text of the article. Read background information on the study. Watch a related video on WebMD.
What do you want to be when you grow up? A concert pianist? A doctor?
Watch this clip from KING5's Evening Magazine to learn more about his journey from pianist to perfectionist in search of a cure for brain cancer:
The Spring 2011 edition of BrainWaves is now available online.
BrainWaves is the newsletter of the Swedish Neuroscience Institute. Published quarterly, BrainWaves provides information about neurological conditions treated at the Institute, and also profiles the programs, services, and new initiatives of the institute and its staff.
Also check out our past editions of the BrainWaves newsletter.
SNI is leveraging communication tools that deliver information to patients, referring physicians and the public as a crucial part of providing care at the advancing edge of neurological knowledge. The goals of these tools are two-fold. One goal is to update established patients and their doctors regarding the latest developments in our programs and centers. The other is to lower the barrier for patients and physicians who are facing a new neurological problem to discover tertiary subspecialty care.
A new SNI communication tool
Dan Rizzuto, Ph.D., director of SNI research, and John Henson, M.D., recently launched the SNI blog to complement other communication efforts and to provide a communication outlet for the staff of SNI. The SNI blog offers brief notes about advances in neurological care provided in SNI’s centers, as well as news items about the institute that are of interest to our patients and referring physicians.
Blog content is more dynamic than Web content. Search engines are able to detect targeted key words within each entry, which helps direct highly relevant Web traffic to the blog. This aids in the dissemination of information to patients and physicians. Viewers also can subscribe to an e-mail notification system that will alert them to newly posted material.
Other SNI communication tools
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.
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.
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 firstname.lastname@example.org or 206-320-4080, for more information about TCD for detection of cerebral microemboli.