Wednesday, October 23, 2019

Seven minutes in stroke - Dr A Antonio Arauz

Dr A Antonio Aruz
Stroke Clinic
Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suárez
Mexico City

1. What inspired you towards neuroscience?

Honestly, my first option was cardiology, but I was accepted into a great Mexican Neuroscience Institution (Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez) and there I began to deepen in Neurosciences. It has been a great adventure. The challenge of neurological diagnosis, the exact location of brain lesions, based on clinical findings. The breakthrough in diagnostic and treatment methods are fascinating. 

2. Why stroke?

Stroke is one of the leading causes of death in Mexico, but mainly it is the leading cause of disability. In the 80s the study of patients with stroke was completely different, but it was a major clinical diagnostic challenge. That’s why I decided cerebrovascular field.  I’am lucky to have witnessed the great changes in the diagnosis and treatment of stroke. At the beginning (20 years ago) that I began the study of cerebral vascular diseases, there was little that could be done in the acute treatment of ischemic stroke. Things are now, totally different. 

3. What have been the highs so far?

To be able to work in a multidisciplinary team, including neurosurgeons, interventionists and rehabilitation specialists, and with colleagues from other countries, in multinational groups, but mainly participate in the training of medical doctors, neurologists, and stroke neurologists.
I still feel excited that our manuscripts are accepted and see them published. And of course, seeing the recovery of a patient after stroke is always a great achievement. 

4. What have been the lows?

It has always been frustrating to have nothing to offer to our patients and this is frequent in many cases. Although there are great advances in acute ischemic stroke, there is little we can do in intracerebral hemorrhages, in some vascular malformations, etc. 
Driving change in the national/local stroke care system it is often frustrating. The public policies in my country are almost impossible to modify and try to have an acute stroke treatment system, is still a pending issue in Mexico. 

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

It is always a challenge. In my case, it has been changing over time, with the different stages of growth of my sons. However, family is always the priority. Thankfully my wife Alma, and my son’s Eduardo and Fernando have been very supportive.

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

I am very grateful to Fernando Barinagarrementeria for introducing me to the field of vascular Neurology. Over the time Fernando has been not only an academic mentor. He has been a friend and I have had the privilege of sharing with him many projects, meetings, trips, as well as discussions about stroke, politics and life itself.
During my time as a Neurology resident, in addition to Fernando, there were some other professors who undoubtedly influenced my training. 

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

I am also fortunate to have been able to have very important collaborations. For example with Peter Sandercook and the IST3 group, or in the SPS3 project with Oscar Benavente and Bob Hart. 
Other important collaborations have arisen from my interest in arterial dissections and cerebral venous thrombosis in our population, which has allowed us to participate in collaborative work groups. 

More recently in the ESUS working group and NAVIGATE ESUS trial. Although this was a negative trial, it has generated many manuscripts published in high impact journals. A good example is the sub-analysis of the regional, sex and age differences in Diagnostic testing published in International Journal of Stroke. 

These collaborations have been built by the publication on specific topics, by reference of other colleagues or by previous collaborations. 

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