stroke research in east kent prevention and treatment present and future dr tom webb consultant...
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Stroke Research in East KentPrevention and Treatment
Present and FutureDr Tom Webb
Consultant Neurologist and Stroke PhysicianEKHUFT
June 2014
Stroke Research in East Kent
• Impact of stroke – the importance to research• Improving our prevention of stroke• Improving our treatment of ischaemic stroke• Improving recovery following stroke
Stroke Research in East Kent
• Impact of stroke – the importance to research• Improving our prevention of stroke• Improving our treatment of ischaemic stroke• Improving recovery following stroke
Vascular damage to the brain
• 86,000,000,000• 2,000,000/ min die after stroke• Brain ages by 4 years every hour
untreated
‘Frequent, dangerous, expensive…’
• Commonest cause adult disability
• Major cause of mortality• £3 -£8 bn annual cost to
UK
TIAs - An opportunity to intervene
Rothwell P et al, Lancet, 2007. 370(9596): p. 1432-42.
TIAs - An opportunity to intervene
Rothwell P et al, Lancet, 2007. 370(9596): p. 1432-42.
Risk factors we can treat
TIA/ Stroke
Risk factors we can treat
Risk factors we can treat
Risk factors we can treat
CMBs
Risk factors we can treat
OSACMBs
Risk factors we can treat
OSACMBs
?
Risk factors we can treat
OSACMBs
??
Risk factors we can treat
OSACMBs
??
?
Risk factors we can treat
OSACMBs
??
?
Risk factors we can treat
OSACMBs
??
?
?
Risk factors we can treat
OSACMBs
??
?
?
Risk factors we can treat
OSACMBs
??
?
?
?
Risk factors we can treat
OSACMBs
??
?
?
?
Risk factors we can treat
OSACMBs
??
?
?
?
What are we studying?
Diagnosis in East Kent TIA clinic
Diagnosis in East Kent TIA clinic
Diagnosis in East Kent TIA clinic
A unique resource
• 365/365 (33%)• Consultant review
(33%)• MRI for all patients
(16%)• 1500 TIA/ minor
stroke patients 2011-13
Cerebral Microbleeds – small vessels, big problems
• Haemosiderin perivascular deposits• 5 % of well population• 30 % of ischaemic stroke• 60 % of haemorrhagic stroke• May present like TIAs
Cerebral Microbleeds – small vessels, big problems
• Haemosiderin perivascular deposits• 5 % of well population• 30 % of ischaemic stroke• 60 % of haemorrhagic stroke• May present like TIAs
CMBs – what East Kent data might tell us
• How common are they in TIA?• How common are the TIA-like episodes?• Should we look for them with MRI?
CMBs
• Work with UCL research group• Blinded review of East Kent MRs• Correlation with clinical features
Obstructive Sleep Apnoea
• Nocturnal hypopnoea, apnoea and hypoxia• Up to 25 % of men affected• Increased risk of cardiovascular disease…• … and stroke?
OSA and Stroke - Correlation or causation?
• Over 60 % of stroke have OSA• Stroke may cause OSA (but TIAs unlikely to…)• Complex relationship of risks
OSA and Stroke in East Kent
• Examine incidence of OSA in East Kent TIAs• Epworth scores and sleep studies• Should we be screening and treating OSA in TIA clinics?
Other ideas?
• Atrial fibrillation?• ABCD of TIA and
Stroke?• Relevance of MRI
abnormalities
Mortality from Stroke is falling…
Thank you