Seven minutes in stroke - Brad Sutherland

 Image courtesy of University of Tasmania

1. What inspired you towards neuroscience? 

One of the big unknowns in the world is how does the brain actually work. We know so little about this organ yet it controls everything we think, say, do. Discovering new phenomena associated with brain function makes neuroscience so exciting. That is why when I began research within neuroscience.

2. Why stroke?

The lab that I completed my Honours and PhD theses in predominantly worked on how various inflammatory pathways were involved in the wound healing process (Dr Ian Appleton, University of Otago). We decided to apply those same principles to the brain by investigating inflammatory pathways after stroke. I always had an interest in stroke and what happens to the brain after a stroke. My grandfather died very suddenly after a stroke and so when I began researching the brain, my family history enticed me to study this devastating condition.

3. What have been the highs so far?

Completing a PhD is a massive achievement and was such a relief to get through. Doing a post-doc at the University of Oxford was an amazing experience and has opened so many doors subsequently. Also, being involved in a Fondation Leducq Transatlantic Network of Excellence during my time in Oxford allowed me to meet and collaborate with some of the world’s leading neuroscientists which continue to this day. These collaborations resulted in a Nature paper looking at the role of pericytes, a specialised cell localised on capillaries, in controlling blood flow in the brain and how this is affected by stroke.

4. What have been the lows?

A research career is always full of highs and lows. I think everyone thinks why bother when you miss out on a grant or get a paper rejected but that is part and parcel of being a researcher. While I always feel disappointed when an experiment doesn’t work, I see it as an opportunity to move forward with that knowledge in mind by approaching the problem in a different way.

5. How do you balance work life with the needs of home life?

An academic career is always a challenge to balance work life with home life. But keeping that work/life balance is extremely important. Once I get home from work, I tend to forget about work and enjoy family time for a few hours. And you can always continue work later if needed. Also, having hobbies is critical as this allows exercise, getting out of the house as well as enjoying activities with families and friends.

6. Who are your most important mentors and how did you find them?

My most important mentor has been Prof Alastair Buchan from the University of Oxford. I spent 7 years working in Oxford with Alastair and I learnt so much from him, and through him I have made so many connections with leaders in the stroke and neuroscience fields. I met him by visiting him and his lab in Oxford which led to being able to do a post-doc in his lab. Recently, I have been working with Prof David Howells (Florey Institute and University of Tasmania) who is helping me further my stroke research career.

7. What are your most important collaborations and how have you built them?

During my time in Oxford, I was in the very fortunate position of being a part of a Fondation Leducq Transatlantic Network of Excellence. This involved our lab collaborating with multiple leaders in the Neuroscience field including Profs Brian MacVicar (University of British Columbia), David Attwell (University College London), Martin Lauritzen (University of Copenhagen), Eric Newman (University of Minnesota) and Serge Charpak (INSERM) looking at energy supply in the brain and how this is disrupted following stroke. This work led to very fruitful collaborations, a number of discoveries, multiple papers and life-long friendships with researchers from these labs.

 Dr Brad Sutherland is a Senior Lecturer in Neurosciences and Brain Plasticity, Office of School of Medicine at the University of Tasmania brad.sutherland@utas.edu.au

Stroke survivor stories - Mrs. Chithra Padmini

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?  

Ten years back, when I was forty-two, I flew to Dubai to be employed as a domestic helper. When I was on the verge of fifty, I had ill health, so I flew back to Sri Lanka in late September 2016. The following day, suddenly, I fell down in my room. I noticed that I could not talk and move my right arm and right leg.

Could you access hospital?

I was helpless because nobody was at home. I started dragging myself along the floor slowly and was able to come to the verandah. There I saw a neighbour, so I waved my left hand which was movable. Luckily, she saw me and ran to me quickly. Then with the help of my neighbours, I was admitted to a local hospital and was found to be anaemic and was transfused with two pints of blood. On the same day, I was transferred to the National Hospital in Colombo for a CT scan of my brain. I was diagnosed as having a stroke and was transferred to the stroke unit of the National Hospital.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?

By the time I was admitted to the stroke unit, I was unable to talk, walk and swallow. But my vision, hearing and bodily functions were not affected. I feared I would be bed-ridden and I felt that my life was not worth living disabled. I started losing my courage, strength and hopes.

       

What was your experience of treatment and/or rehabilitation and therapy?

The next day, I heard a gentle female voice from my bedside. She was the Doctor-in-charge of the stroke unit. She took plenty of time to explain my condition to me and my family and she advised me to engage in physiotherapy, occupational therapy and speech therapy daily. She also explained the importance of not losing courage. I just listened to her with tears in my eyes. I could not do anything else as I could not utter a word. 

What has helped you in your recovery?

Slowly, day by day, I started improving with medications and the rehabilitation programme. At the end of the first week, I was able to talk, sit up in the bed, walk with support and swallow semi solids. My hopes started blossoming. Everyday, I had to undergo well planned schedules of physiotherapy and occupational therapy. The counsellor was a kind lady who met me frequently. The social worker helped me to get the financial support that was granted by the government. After staying one month in the stroke unit, I was completely recovered without any residual deficits which I did not expect at all at the outset.

How did your family and friends feel and respond?

Although members of my family were shocked and disappointed, they gave me the maximum care and support that was vital at that moment. 

Stroke survivor stories - Mak Kwok Fai

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?  

I got a stroke when I was 29. Mine was a haemorrhagic stroke.

Could you access hospital?

One afternoon, in the office of the insurance company I worked for, a severe pain shot through my head and I felt dizzy. My colleagues called an ambulance and sent me to hospital immediately.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?

The experience was frustrating. Sometimes, I would throw a tantrum, and refuse to go for therapy or do any exercises on my own. But then my mother would cry, and I would relent, realising that I owed it to her to recover. She would said, “People go through ups and downs, and that to reach up is to move forward.”

What was your experience of treatment and/or rehabilitation and therapy?

I spent my 30^th birthday at the Singapore General Hospital. My friends and colleagues surprised me on my birthday, bringing me a cake. The doctors even gave me a birthday card, while the nurses sang a song together with me. This was the most memorable birthday I have ever spent.

I was hospitalised for a total of three months. After I was discharged and went home, I initially moved into my mom’s room so that it was easier for her to take care of me. I was still wheelchair-bound at the time, and was unable to speak nor write. I underwent physiotherapy, occupational therapy and speech therapy to improve my physical motion and speech.

What has helped you in your recovery?

I feel that there is one common remedy that is able to help all the stroke survivors, regardless of age, sex or race, and that is — LOVE.

After I recovered sufficiently, I wrote a book: “My Stroke Experience at 29”. The message I wanted to spread is that stroke does not happen only to the elderly; in fact, younger patients, who assume it cannot happen to them, may be caught unawares.

Every fall, every step, and every experience after my stroke has been a learning process for myself and my family members. With the help of everyone who loved and cared for me, I grew to become more independent. They believed in me. And their loving care was the best and truest gift I have ever received in my life.

What have been/are your fears?

After I regained consciousness, I realized I suffered a stroke and had already undergone brain surgery. My first thought was “Why me, how can it happen when I was so young?”

How did your family and friends feel and respond?

My family and friends would visit me daily in the hospital, while my colleagues saw me there regularly too.

My mom cared for me the entire day at first, and I am deeply grateful for her love and sacrifices through this difficult time.

Seven minutes in stroke - Adam Piechna

1. What inspired you towards neuroscience?

As my background is technical science, my first contact with neuroscience was during a numerous conversations with my PhD mentor of that time, professor Krzysztof Cieślicki. Then I first heard about Circle of Willis and many interesting physical phenomena. They were mainly connected with cerebral blood flow physics and modeling, while the clinical issues were in the background. Then I met professor Bogdan Ciszek from the Departments of Anatomy and Forensic Medicine Warsaw Medical University. A number of potential unknowns and their importance in clinical application were the main inducement to focus on neuroscience in my subsequent research.

2. Why stroke?

Because it is one of the most dramatic and unforeseen diseases; because it is unfortunately real and can affect everybody, and because I have met people who want to do something about it.

3. What have been the highs so far?

I would say that working in the team of people who are the true Scientists, who are working only because of curiosity and willingness to make a change. Especially working with physician Leszek Lombarski who shares his enthusiasm with the whole team. Of course, a palpable high is getting the high impact journal publication, which is a clear sign for us, that  our results are important and could benefit many people.

4. What have been the lows?

Realizing how far it is from the results of laboratory research to clinical application…

5. How do you balance work life with the needs of home life?

Probably I do not, however every evening I try to find some time to spend with my wife. Also, at least once a year, we  go for a long sport climbing trip.

6. Who are your most important mentors and how did you find them?

On the technical part of our research it is my supervisor professor Krzysztof Cieślicki. On the medical side it is professor Bogdan Ciszek. Their knowledge is admirable and stimulating. My first mentor was and still is professor Janusz Piechna – my father, he is always my guiding light.

7. What are your most important collaborations and how have you built them?

As we are working on the borderline of two fields of knowledge, finding a common language is the most important thing. My most important collaboration with Departments of Anatomy and Forensic Medicine Warsaw Medical University was built with help of my supervisor’s connections. Also I was heartily accepted as the group member by the professor Bogdan Ciszek.

Seven minutes in stroke - Anna Weichselbaum

1.  What inspired you towards neuroscience?

During my medical studies in Debrecen, Hungary I was introduced to a highly interesting and complicated field which had still so many unknown aspects.

The fact that many neurological diseases have still no treatment and cause unfortunately disability and death, made me feel challenged and it motivated me to search for answers.

My goal in life is to contribute to this mysterious field and improve and save people’s life.

2. Why stroke? 

Stroke can unfortunately be a very devastating disease. It is pleasant to be able to improve and to cure people which suffer from stroke. Seeing my patients smile, after being able to move again their limb or to be able to speak, worth’s everything for me.

3. What have been the highs so far?

Besides being a resident, I am currently taking part as well at the ‘European master in stroke medicine’ which is taking place in Austria. This course is a great opportunity to acquire knowledge in stroke medicine from the best neurologists and neuroscientists in this field. Later on, after finishing my residency, I would like to complete PhD studies.

4.   What have been the lows?

Losing patients life despite performing all lifesaving treatments and methods, makes me still disappointed.

In addition, the difficulty combining working full time as a neurologist, being a mother and doing research.

5.   How do you balance work life with the needs of home life?

I think that to find the right balance is pretty difficult for every physician especially for a woman and mother. Being raised by my mother which is a great physician and mother, made me being able to incorporate both things in life. Thanks to precise planning its working not bad so far.

6.   Who are your most important mentors and how did you find them?

The decision to become a medical doctor was influenced by my physician mother. I am very happy to have her there always for me and for directing me in my life. My love to neurology was attributed to my neurology professor during my medical education Prof. Dr. László Csiba. The way he taught fascinated me and I have decided to become a neurologist and later on to teach students the same great way that he performed it. I am as well very thankful to Dr. Milan Vosko which is the head of the stroke unit in the hospital I am working at. He taught me Neurosonology, clinical oriented case solving and was always there when I needed advices. Furthermore, it was a privilege to get to know Prof. Dr. Michael Brainin during my current master studies and I am looking forward acquiring knowledge from him.

7.   What are your most important collaborations and how have you built them?

Working in a big university hospital requires a good network among cerebrovascular neurologists, radiologists, vascular surgeons and cardiologists.  Currently we are having a very interesting collaboration with our ophthalmology department concerning the treatment of an acute central retinal artery occlusion with Intravenous tPA. International collaborations are the best opportunities to combine different expertise to gain better insights into neurological complex diseases.

Dr. Anna Weichselbaum is a neurology resident at the Kepler University Clinic, department of Neurology II, Linz, Austria

Report of EAN/WSO/AAN/AFAN/IBRO/WFN/IPDMDS 8th Regional Teaching Course (RTC) on Neurology in Sub-Saharan Africa. Maputo, Mozambique 10th -12th November, 2016

The 8th RTC took place in Maputo, Mozambique and was hosted by the Eduardo Mondlane University of Maputo, Mozambique. The RTC, organised by the EAN, was supported by a consortium of African and international scientific societies:

•   Eduardo Mondlane University of Maputo, Mozambique.
  
•   AFAN – African Academy of Neurology
  
•   WFN - World Federation of Neurology
  
•   AAN - American Academy of Neurology
  
•   IBRO - International Brain Research Organisation
  
•   IPDMDS– International PD and Movement Disorder Society
  
•   WSO - World Stroke Organisation
  
  Our gratitude goes to the local organising committee led by Amina Ismael Daude and Lucia Chambal. Her help and the support of the Mozambican Ministry of Higher Education and the Faculty of Medicine at the Eduardo Mondlane University was essential for the success of the RTC. Thanks to their support, 23 young doctors and trainees coming from 12 SSA countries were invited to the 8th RTC and supported by a scholarship from the RTC fund. These individuals were selected by the course organisers from a larger number of neurological trainees who had been put forward by their Head of Department as potential course participants. Thus these selected participants represent some of the very best trainees from across Africa. Many doctors and trainees from the Eduardo Mondlane University and the Maputo Central Hospital as well attended the course; the RTC counted 100 registered participants. The Faculty for the course was truly international. This three-day RTC had three main themes: stroke, epilepsy and HIV and the nervous system in SSA.
  The RTC was also acknowledged by the Mozambican Ministry of Health. Mr. Mouzinho Saide, Vice Minister for Health of Mozambique opened the works of the 8th RTC and stressed the importance of courses such as this Regional Teaching Course for Africa. He welcomed addressing topics such as stroke, HIV/AIDS and epilepsy that are key health issues on the African continent. He thanked the EAN for bringing the course to Africa and allowing Mozambican and African doctors to have access to excellent teaching on site. He finished his introduction by mentioning that in Mozambique, there are only 6 neurologists for 25 million people and expressed the hope that the RTC will enhance interest in neurology among the participants.
  

The Opening Ceremony of the 8th Regional Teaching Course

Faculty: Guenther Deuschl (Germany), Erich Schmutzhard (Austria), Amina Ismael Daude (Mozambique), Albertino Damasceno (Mozambique), Riadh Guider (Tunisia), Augustina Charway - Felli (Ghana), Rufus Akinyemi (Nigeria), Jose Ferro (Portugal), Raj Kalaria (UK), David B. Clifford (USA), Charles Newton (Kenya), Suzaan Marais (South Africa), Christian Napon (Burkina Faso), Jo Wilmshurst(South Africa), Hannack Cock (UK). Case presenters were M. Rabiu (Nigeria), M. Mekki (South Africa) and Cadmiela da Graca Arroz (Mozambique).
The core organisation of the course is led by the “Neurology and SSA” Task Force team at the European Academy of Neurology (EAN) chaired by Prof. Erich Schmutzhard (Austria) together with Ms Eveline Sipido, EAN Liaison Officer. The high international reputation for academic excellence of the course is underlined by the wide range of learned societies and institutions that support this annual course.
The support received from major regional institutions such as the Mozambican Ministry of Higher Education and the Eduardo Mondlane University of Maputo, highlight the importance of the event within Africa. Dr. Augustina Charway- Felli, represented the African Academy of Neurology and Prof. Riadh Gouider participated as WFN envoy to the RTC. Dr Rufus Akinyemi represented the WSO.
The format of the course was a mixture of lectures in the morning, supplemented by a case presentation fitting into the theme of the day. The afternoons were taken up with small group interactive workshops to discuss cases brought by the experts; these sessions were intensive, but proved particularly popular with the participants (and enjoyable for the Faculty!) (see below).

Prof Jose Ferro (Portugal) delivering a presentation on stroke

Other highlights included a ‘video dinner’ interactive session with the faculty on movement disorders and epilepsy and a demonstration by Dr Hannah Cock (EAN Director of Education) of eBrain, the EAN e-learning system. . A clinical case presented by the invited resident Musbahu Rabiu (Nigeria) completed the evening.
It was a real privilege to attend the course as a teacher and to learn from the clinical and scientific expertise of the faculty in the sessions and in the discussions. While the international faculty might bring knowledge of recent scientific advances to the table, the regional faculty brought their extremely rich clinical experience and wisdom in how to apply that knowledge in the diverse health care systems of Africa. Likewise, the trainees brought a great many questions that arose from their daily practice; this unique opportunity for them to ask the Faculty questions and to network with their peers from across the continent was something they really valued. There was also a formal ‘Meet the Professor session’ and a presentation of the EAN-‘s eBrain on-line learning resource, which will be made available free of charge to all low-income and HINARI countries

The meeting was organised to a very high standard, and clearly met the need to build capacity in caring for people with neurological disorders on the African continent, where the burden of disease related to both communicable and non-communicable diseases of the nervous system is high; stroke in adults and - in children - epilepsy and HIV being a major infection of both adults and children being disorders with a high burden of disease in the region.
To meet this continuing need, the EAN-led planning group met in Maputo to plan the next course. The participants at the 8th RTC were asked to list up to three topics of interest they would like to see addressed in a future RTC. From the compilation of the topics received, two that had the highest request were identified for the 2017 RTC.
The 9th RTC will be held in Ouagadougou, Burkina Faso hosted by Prof. Jean Kabore. The dates of the RTC are to be decided.
Following the analysis of the proposed topics and with the input of the faculty, the following topics were identified for the 9th RTC:

1. Neurodegenerative disorders – movement disorders
   
2. Neuromuscular diseases with an emphasis on the clinical aspects
   
3. Spinal cord diseases
   

Given the escalating burden of stroke in Africa, the enthusiasm of the course participants and the very large numbers of questions fielded by the Faculty about stroke over the course of the RTC, I have no doubt that the support from the WSO will prove to have been an extremely cost-effective investment that will help develop a cadre of stroke neurologists in Africa to tackle the emerging epidemic of NCDs there.

Rufus Akinyemi 
Erich Schmutzhard 
Eveline Sipido

Stroke Survivor Stories - Rita Upton

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?  

I was walking down the stairs at home, I can tell you the exact date and time. 8.30am Thursday 11^th September 2008.

Could you access hospital?

My husband recognised I was having a stroke, and as my friend arrived for our walk he told her to call an ambulance. The ambulance was called and I was at the hospital by 9am.

What expectations did you have for your treatment, rehabilitation, therapy and recovery?

I had no expectations as I hadn’t had a stroke before so I didn’t know what was supposed to happen. All I was led to believe was that I was supposed to have a scan within 3 hours – which is what the ambulance staff had told my husband en route to the hospital when he asked about treatment. The ambulance staff had phoned ahead to say I was coming with a suspected stroke. However I had to wait for 36 hours for my scan.  

What was your experience of treatment and/or rehabilitation and therapy?

I had a very bad experience when I was first admitted to hospital, I got lost in the system and it was only due to my husband’s perseverance that the scan took place 36 hours later. Although I arrived at hospital at 9am I did not have the swallowing test until the evening, therefore I was not given a drink all day.

I was transferred into a rehabilitation hospital about a month later and I had an excellent experience there, there was a lovely atmosphere and the staff were brilliant. I had physiotherapy every morning and support from occupational therapists to show me the best and easiest ways to wash and dress myself.

What has helped you in your recovery?

Volunteering has helped me because it gives me a reason to get up in the morning. It gives me a purpose in life rather than sitting at home. It gets you mixing with people again. After a stroke your confidence goes rock bottom.

What have been/are your fears?

Having another stroke basically and not being able to volunteer because if I sat at home I’ll get depressed.

How did your family and friends feel and respond?

My family and friends were fantastic. My husband and I had a very close circle of friends and they never forgot who I was inside. I was still Rita inside. My husband was so positive and if it wasn’t for him I wouldn’t be where I am. My husband has been my tower of strength and my rock.