Monday, November 28, 2016

Global Stroke Statistics

Seven minutes in stroke - Mirjam Heldner



1. What inspired you towards neuroscience?
As a child I had a deep fascination in astronomy and in the human body and being. I did not decide to become an astronomist or astronaut, but to study medicine. During medical school, I enjoyed reading neuroscience related books and articles, the neurological lectures and my elective Neurology rotation in the 6th year of medical school. That’s when I decided to become a Neuroscientist. Why did I choose this medical specialty rather than another one? I think neuroscience mostly resembles my other never-changed interest and fascination about astronomy, in it’s complexity, beauty and amount of unanswered questions. More importantly, both neuroscience and astronomy rely on profound examination and thinking. They even share some terms such as “penumbra“, which furthermore relates to the stroke field.
2. Why stroke?
I have always liked internal medicine besides neuroscience. Stroke patients frequently have
internal medicine related problems, much more than patients with many other neurological
diseases. Furthermore, the question ‘why stroke?’ is linked to my decision to study medicine and not to become an astronomist or astronaut. Even since I was little, I have wanted to  ease the suffering of children, adults and animals. For example, I saved several snails from being crushed deliberately by a naughty school mate. 

Stroke devastates lives at any age and worldwide, and is the leading cause of disability and the 2nd (3rd in Europe) leading cause of death globally. Stroke is treatable, but there is still a long way we have to go reducing the suffering stroke causes. I can contribute to this journey with my enthusiasm, not only as a stroke clinician, but also by being active and highly motivated in teaching and in stroke research - and importantly not only locally in Berne, the place with very good opportunities.

3. What have been the highs so far?
There are many. I wish to highlight the following ones:
a) Experiencing several grateful patients and relatives, frequently because of good or even
excellent outcomes after acute stroke treatment.
b) Having new ideas, finding new answers to open questions in the stroke field.
c) Working in our Bernese Stroke Unit, at our Bernese Stroke Center with a very nice team.
d) Participating at ESO conferences and schools and meeting many motivated Strokologists
from all over the world with different cultural backgrounds. Several of them have become my
good friends.
e) Currently, having the opportunity doing a Stroke Research Fellowship in Oxford/UK (Oxford Vascular Study Group, Prof. Dr. Peter Rothwell).
f) Teaching students, nurses and the public about stroke medicine.
g) That my grandmother got a bridging thrombolysis at our Bernese Stroke Center for her major stroke due to a basilar artery occlusion in March 2014 and that she keeps telling me, that she is happy having survived the stroke, with her life, which I really can see in her eyes.
Objectively she has a mRS of 4 and moderate post-stroke dementia.
h) Receiving an ESO prize and getting grants for interesting research projects.

4. What have been the lows?
Realising, that opportunities as a stroke patient and as a strokologist differ a lot worldwide.

5. How do you balance work life with the needs of home life?
My hobbies and social network are important for me. I like exploring and I often travel  worldwide to broaden my horizon and to get insight into different ways of living. I enjoy spending time in nature. I do sports, especially skiing, swimming, hiking and since I am in Oxford, I have started rowing - sometimes at 6am, several times a week and including gym sessions. I enjoy thought-provoking conversations, reading good books of all sorts, taking photographs, visiting museums, attending cultural events and classical music concerts.

6. Who are your most important mentors and how did you find them?
Prof. Dr. Heinrich Mattle (Berne): who as a great Neurologist and Strokologist contributed a lot to my interest and fascination in stroke in my early career and paved my way into the world of stroke medicine.
Prof. Dr. Urs Fischer (Berne) and Prof. Dr. Marcel Arnold (Bern): Who have been extremely
helpful through my professional journey so far. This by strongly supporting my clinical and
research interests in the stroke field since I started my Neurology training, providing me with
several opportunities for my professional development.
PD Dr. Simon Jung (Berne): Who has mostly been my day-to-day supervising clinical stroke
consultant so far. He has greatly fascilitated my delight in working in the stroke field. This by
sharing his fascination in stroke and his talent asking pathophysiological, investigational and
treatment-related questions and trying to answer them in clinical work and research.
Prof. Dr. Peter Rothwell (Oxford): Who gave me the chance, to do a Stroke Research Fellowship in Oxford, which is broadening my horizon not only from a professional, but also from a personal and social point of view.

7. What are your most important collaborations and how have you built them?
I think the key factor for collaborations is to join open questions, ideas and wishes to unite efforts.
I have different collaborations locally, and within and outside Switzerland. At our Bernese
University hospital, the collaboration with the Neuroradiologists is outstanding with a long tradition and has boosted the (hyper-)acute stroke treatment at our center. Other collaborations that are important include the collaborations with different Swiss strokologists through a straight forward professional community and also collaborations worldwide. I made the initial contact of many of my collaborators through the ESO conferences or schools if not through my mentors.

Thursday, November 24, 2016

Stroke Survivor Stories - Ron Smith

The stories of stroke survivors are what drives our fight at the World Stroke Organization to achieve our goal of a world free from stroke. Welcome to our Stroke Survivor Stories series, which we'll pop up on the blog every Thursday, you may wish to contribute to this poignant narrative of stroke globally. Please contact Sarah.Belson@stroke.org.uk

Where were you when you had your stroke?  
The initial mini strokes happened at my home in Nanoose Bay, British Columbia. I had my stroke on November 19, 2012, a day, as a stroke survivor, you never forget and your family never forgets. So many people are affected

Could you access hospital?
I had what the emergency doctor referred to as a stuttering stroke. I think what he meant by this is that I had a series of smaller strokes at home before the bigger stroke hit. After the major event, which happened in the waiting room of emergency or I wouldn't be here today, I wasn’t having thoughts that registered. I inhabited a place I can only describe as ‘limbo’.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?
I was in denial from the onset, an all too common response to the symptoms of stroke. My right side was paralyzed. This was frightening. Initially my speech was impaired but this righted itself fairly quickly. With a little effort, people could understand me after a few days. Perhaps the biggest problem was that I didn’t feel like I belonged to the world anymore even though I felt my cognitive powers were still intact. The combination of loss of physical and emotional control and the sense of no longer belonging to the everyday world resulted in severe depression. After a couple of weeks I decided I could either wallow in self-pity or take action. In combination with physical therapy I decided to meditate. I also decided, very deliberately, that I needed to take a positive and proactive approach to my recovery. I have never stopped therapy. I have read as much as possible by other stroke survivors and a number of books on the brain, brain plasticity and new forms of therapy. I also used memory to find my way back to myself, to the person I had been. Patience is vital to the stroke survivor’s well-being because recovery can be very slow.

What was your experience of treatment and/or rehabilitation and therapy?
I have two complaints: My formal therapy was terminated far too early; and all forms of therapy need to be tailored to the individual; that is, personalized. The patient needs to be consulted if therapy is to be effective. Too many assumptions are made about what will work. Anecdotal accounts can be every bit as reliable and as useful as clinical research if collected properly.

What has helped you in your recovery?
Before my stroke I taught English and Creative Writing at the university level; I owned a publishing company; and I wrote and published books. I was lucky, writing was my life and was a vocation to which I could return with relative ease. Eight months after my stroke I decided to write about my stroke experience. My only handicap was that I had lost the use of my right arm and hand. I typed my book, The Defiant Mind: Living Inside a Stroke, over 300 pages, with the index finger on my left hand. The Defiant Mind is a book about the wonder that is the human brain, both before it has been damaged and after. I hoped the book would be useful to other stroke survivors, care-givers and therapists. I also hoped it would help the general public understand what a stroke is, at least from my perspective. But if my book doesn’t achieve these goals at least it will have been another form of therapy for me; another way to explore my own experience. Writing also puts my brain to work, which seems essential to my recovery. I also take walks, cane assisted, amongst trees, practicing Japanese 'forest bathing' or Shin-rin YokuScientific studies indicate that trees help reduce the stress hormone, cortisol, and increase the immune defence system. And at least three to four times a week I go to a local pool. I can exercise in water with abandon. I love the water’s primal feel and wish it had been a part of my therapy from the beginning.

What have been/are your fears?
Of course, always at the back of my mind is the fear of having another stroke, a risk for which I'm genetically predisposed. But I tuck this away and carry on.

How did your family and friends feel and respond?
I've been very fortunate; my family and friends have been incredibly supportive and loving.

Thursday, November 3, 2016

Stroke survivor stories - Jessica Thåström

The stories of stroke survivors are what drives our fight at the World Stroke Organization to achieve our goal of a world free from stroke. Welcome to our Stroke Survivor Stories series, which we'll pop up on the blog every Thursday, you may wish to contribute to this poignant narrative of stroke globally. Please contact Sarah.Belson@stroke.org.uk

 
Where were you when you had your stroke?  
My stroke survival story is somewhat prolonged, way more than it should have been allowed to be. 3 days after my sixteenth birthday I laid in bed listening to music in my headphones when suddenly my head exploded with a monstrous pain. But I wasn't paralyzed right away. I was only 16 so I thought it was a migraine and took an aspirin. But the pain kept on going like a intense roller coaster of torture for twenty four hours a day.

Could you access hospital?
I reached out for help but the health care system waved me off and said I was stressed... I wasn't stressed, less than 2 weeks into my 10th grade. September 11th 2007, 27 days after my head exploded, I woke up in my bed ready for school - but suddenly I couldn't move my left arm. I had a stroke during my sleep. Soon after that the ambulance rushed me to the hospital where they could see I had had both an ischemic stroke and a cerebral hemorrhage. I was hospitalized for 86 days.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?
The first month is almost blacked out and the others was brutally traumatizing. I was blue-eyed and persuaded that I magically would become myself again. But I never did.

What was your experience of treatment and/or rehabilitation and therapy?
The hospital staff were horrible and didn't know shit about how to treat a teenage stroke survivor. The whole thing was chaos.

What has helped you in your recovery?
I felt my future was shattered before it even had a chance to begin, and so I slipped into a deep depression that lasted for 9 years. The hospitalization caused me Post-Traumatic Stress Disorder and I've been in therapy for a long time. The only thing that has helped my recovery is Conductive pedagogy, and my love for the Buddhist Community. I've manage to publish a book about my story (childhood dream was to become a professional dancer OR an author). I've also managed to overcome my social shyness and make public lectures about my story and stroke in general. It wasn’t until 5 years after my stroke that I realized the importance of quality of life and inner peace even though I have stroke. The health care system seem to want me to stay in my PJ's and live within their walls. I want to dress up, be beautiful, laugh, party and make personal progress a success so that I can celebrate my stroke anniversary and not remember September 11th as a sad day.

What have been/are your fears?
My biggest fear was to never be able to dance again and I was also afraid of being isolated from the world since I was now SICK. I learned to walk with a cane after 3 months and I need it to this day. I still cannot dance. 

How did your family and friends feel and respond?
My friends turned their backs on me and my family was panicking and brought even more chaos into my already chaotic world. I had no support from anyone, left alone in a pile of limbs refusing my commands. I was also left with invisible disabilities such as severe fatigue.


Stroke survivor stories - Jessica Thåström

The stories of stroke survivors are what drives our fight at the World Stroke Organization to achieve our goal of a world free from stroke. Welcome to our Stroke Survivor Stories series, which we'll pop up on the blog every Thursday, you may wish to contribute to this poignant narrative of stroke globally. Please contact Sarah.Belson@stroke.org.uk

 
Where were you when you had your stroke?  
My stroke survival story is somewhat prolonged, way more than it should have been allowed to be. 3 days after my sixteenth birthday I laid in bed listening to music in my headphones when suddenly my head exploded with a monstrous pain. But I wasn't paralyzed right away. I was only 16 so I thought it was a migraine and took an aspirin. But the pain kept on going like a intense roller coaster of torture for twenty four hours a day.

Could you access hospital?
I reached out for help but the health care system waved me off and said I was stressed... I wasn't stressed, less than 2 weeks into my 10th grade. September 11th 2007, 27 days after my head exploded, I woke up in my bed ready for school - but suddenly I couldn't move my left arm. I had a stroke during my sleep. Soon after that the ambulance rushed me to the hospital where they could see I had had both an ischemic stroke and a cerebral hemorrhage. I was hospitalized for 86 days.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?
The first month is almost blacked out and the others was brutally traumatizing. I was blue-eyed and persuaded that I magically would become myself again. But I never did.

What was your experience of treatment and/or rehabilitation and therapy?
The hospital staff were horrible and didn't know shit about how to treat a teenage stroke survivor. The whole thing was chaos.

What has helped you in your recovery?
I felt my future was shattered before it even had a chance to begin, and so I slipped into a deep depression that lasted for 9 years. The hospitalization caused me Post-Traumatic Stress Disorder and I've been in therapy for a long time. The only thing that has helped my recovery is Conductive pedagogy, and my love for the Buddhist Community. I've manage to publish a book about my story (childhood dream was to become a professional dancer OR an author). I've also managed to overcome my social shyness and make public lectures about my story and stroke in general. It wasn’t until 5 years after my stroke that I realized the importance of quality of life and inner peace even though I have stroke. The health care system seem to want me to stay in my PJ's and live within their walls. I want to dress up, be beautiful, laugh, party and make personal progress a success so that I can celebrate my stroke anniversary and not remember September 11th as a sad day.

What have been/are your fears?
My biggest fear was to never be able to dance again and I was also afraid of being isolated from the world since I was now SICK. I learned to walk with a cane after 3 months and I need it to this day. I still cannot dance. 

How did your family and friends feel and respond?
My friends turned their backs on me and my family was panicking and brought even more chaos into my already chaotic world. I had no support from anyone, left alone in a pile of limbs refusing my commands. I was also left with invisible disabilities such as severe fatigue.


Seven minutes in stroke – Andreas Charidimou MD PhD MSc (Clinical Neurology)

Dr Andreas Charidimou is currently a post-doctoral clinical research fellow in Stroke at the Hemorrhagic Stroke Research Program,JPK Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
Twitter: @microbleeds

1. What inspired you towards neuroscience?
The mystery of the brain intrigued me since I was a medical student. The ‘fetishism’ of studying and trying to understand the most ‘complex structure in the universe’ was sparked by three books that I came across in the 2nd year of medical school: Eric Candel’s Principles of Neural Science, Vilayanur S. Ramachandran’s Phantoms in the Brain and Oliver Sacks’ Awakenings. I got my first taste of clinical neurology during my Neurology rotation in the 5th year of medical school at the Eginition Hospital, University of Athens, Greece. We had a great Lecturer of Neurology (Constantin Potagas) who had an amazing talent for bringing the subject to life. I knew that this was my sort of ‘calling’ and from that moment I couldn’t really see how anything in medicine could have ever been more interesting!

2. Why stroke?
Stroke, because it is such a common and devastating disease, but with so many things that could be done to further our knowledge and help patients - I am really hoping to contribute in some ways towards this direction. When I started my acute neurology rotations, one of the first patients admitted was an elderly lady with an MCA stroke. I felt really frustrated by the general nihilistic approach at the time, with so few things to offer for stroke patients, especially compared to other acute syndromes, including acute coronary disease. Some months later, and largely by chance, I had the opportunity to do a clinical attachment to the only comprehensive state-of-the-art stroke unit in Athens, at the Alexandra hospital, Greece, under Konstantinos Vemmos. It was there that I realised the exciting combination of different medical disciplines involved in acute and chronic stroke pathophysiology and clinical care of stroke patients, including neurology, neuroimaging, internal medicine etc. It was also encouraging and inspiring to see how clinical stroke research is truly intertwined with stroke medicine and how far this approach can get us.

3. What have been the highs so far?
There have been so many highs. Perhaps the most life-changing one was moving from Greece to London, UK to continue pursuing my research career at Queen Square, UCL, which led be to a PhD in cerebral small vessel disease and intracerebral haemorrhage. Well, during these years the satisfying moments have been many, both academically and personally. Becoming part of the wider small vessel disease community and the smaller cerebral amyloid angiopathy family has been amazing. Equally life-changing, was then moving from London to Boston, USA to my current position as post-doctoral fellow at the Hemorrhagic Stroke Research Program in Massachusetts General Hospital. The best part of this adventure is of course meeting so many interesting people around the world and making good friends, which, at the end of the day, it’s all that matters.

4. What have been the lows?
Occasionally, some rejection letters from journals! The slow progression in prevention and treatment of small vessel disease and vascular dementia. Also, the realization that working in research can occasionally be incredibly competitive, and the inherent flaws resulting from how the research academic system is structured which to a certain extend can prevent progress. But this a big topic for a lengthy discussion!

5. How do you balance work life with the needs of home life?
Achieving such a balance is really challenging and almost a lifelong exercise! It is always useful to put things into perspective and enjoy time with family and friends. I am very lucky because my family members are very supportive, especially my partner.

6. Who are your most important mentors and how did you find them?
Real mentorship is a complex matter. I am grateful to many generous and interesting people, whom I was lucky enough to encounter in my professional life. Among them, my primary PhD mentors, David Werring at Queen Square, UCL who have generously provided me with professional opportunities that were important steps in my career and shaped me as a researcher. My secondary PhD advisor, Rolf Jager, also at Queen Square, UCL who trained me in clinical neuroimaging and . I am grateful to both for their support and trust. My academic life wouldn’t have been the same if I wasn’t lucky enough to meet Jean-Claude Baron, a great mentor generously sharing his ideas, experience and passion for cerebrovascular disease. My current mentors here at MGH, especially Steven Greenberg, is an amazing source of advice, knowledge and inspiration and it’s a unique experience being part of this group.

7. What are your most important collaborations and how have you built them?
During the last few years I have had the pleasure to collaborate on multiple projects with amazing and very generous colleagues in the field of small vessel disease and intracerebral haemorrhage.

My research has always been very clinically-oriented, and collaborations grown around key clinical questions in our field. Currently, important collaborations include those within the cerebral amyloid angiopathy community in building large multicentre cohorts to definitely address relevant clinical questions. Building and being part of these collaborations has been among the most fulfilling experiences.

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