The STICH II Trial is a surgical trial in sponatenous lobar Intracerebral Haemorrhage or ICH. The Trial has a target of 600 patients to reach before 31st May 2012. Currently over 100 hospitals worldwide are participating, including 18 in the UK. If you are registered and would like some promotional material to distribute to your colleagues / a member of the STICH II team to visit your site, please do send an email to  stich@ncl.ac.uk

STICH was a prospective randomised trial to compare early surgery with initial conservative treatment for patients with spontaneous supratentorial intracerebral haemorrhage.

The link for the STICH II website is: http://research.ncl.ac.uk/stich/

The 20^th European stroke Conference is starting today 24^th May 2011 in Hamburg Congress Centre with teaching courses and update sessions for Nurses and Allied Health Professionals. The main teaching courses for the first day are: stroke and headache, Haemorrhagic Strokes, stroke complications in the acute Phase, stroke syndrome of the posterior circulation, Lacunar stroke and cerebral small vessel disease and advances in dissection.

There are more teaching courses about secondary prevention of stroke/TIA in high risk patients, iatrogenic stroke, stroke in the young adults and difficult treatment management decisions in acute stroke. There is a workshop on 24^th May for young stroke physicians as well.

The update session for the nurses and the allied health professional are about recovery and rehabilitation after stroke.

For the tenth year running the stroke conference team in Wales is organising the Welsh Stroke Conference and managing to attract hundreds of Stroke Doctors and allied health professionals.

The Conference this year will be held at the River Front Centre in Newport/ Wales and on 17th June 2011. The main speakers are Professor of Neurosurgery in Newcastle upon Tyne David Mendelow. His lecture is about Intracerebral Haemorhage: time is brain.

From Houston, Sean Savitz, Associate Professor in Neurology is speaking about Emerging therapies for acute stroke. Dr. Savitz main interest is in stem cell therapy for stroke.

From University of Southampton, Professor of restorative neuroscience, Jane Burridge is talking to the conference about Robotics for stroke rehabilitation.

Professor Roger Boyle CBE is presenting Bhowmick Lecture this year. The subject of the lecture is implementing a stroke strategy. Dr. Anthony Rudd, Consultant Stroke Physician in St Thoams’ hospital in London is briefing the conference about the results of the Royal College of Physicians Audit for stroke in Wales.

There will be two parallel sessions in the conference as well. The first one is updating the audience about the latest developments in the field of stroke rehabilitation and the second is an update about uncommon causes of stroke. A space has been allocated for the stroke researchers posters from all over Wales.

Conference program

Registration Form

Chairman:

Professor Didier Leys

President of the European Stroke Organisation
Professor of Neurology and Head of the Neurological Department Lille University Hospital

10 June 2011
Congress Center, London

CPD accreditation applied for by the Royal College of Physicians.
This conference is endorsed by the UK Forum for Stroke Training (UKFST).

Conference theme

Stroke care is a fast moving discipline. With treatments and services improving rapidly, stroke has come a long way in recent years. However, the journey is not over. Research and new technology are constantly pushing the envelope and delivering new therapies, procedures and ways of working. So much so that staying up to date can be a challenge. Recognition of stroke as a medical emergency has also led to a significant reorganisation of services. Now designed to deliver optimal hyper-acute care and improve the outcomes for the growing number of stroke survivors.

Developments and innovation are not however isolated in the acute hospital phase of stroke. Improvements and new ways of delivering care are being pioneered across the stoke pathway by a diverse range of clinical professionals, from prevention through to long term care.

New Frontiers in Stroke is a new conference that has been developed to explore the most exciting current and future development in stroke care. Attendance will allow delegates to hear from leading UK and European stroke experts. They will provide an analysis of all the latest cutting edge stroke science, and explore recent advances in stroke treatment and care. The event explores the whole stroke pathway, featuring presentations from leading professionals, working in many of the key stroke care disciplines. This unique new event will enable you to remain up to date with the latest advances in stroke treatment and care, delivering the key information needed, in an affordable and accessible format.

Why attend this conference?

1. This conference provides all the latest cutting edge advances in stroke treatment in one easy, one day event. Most established scientific stroke events are multi day and even the UK event requires travel to Glasgow.
2. The programme looks across the whole stroke pathway and hears from leading clinicians that work in the various professions that work along the stroke pathway. The event is truly multidisciplinary.
3. The delegate rate for the event will be significantly lower than attending either of the big competitor’s and about half of the normal rate charged by most commercial conference providers in healthcare.

For more information and booking please visit:

www.medineo.org

Following the successful history of the ESC from 1990 to its 20th anniversary conference, the Scientific and Programme Committees will prepare a truly international conference that will collect excellent work of basic science and clinical research related to stroke and cerebrovascular diseases as submitted from continuously increasing numbers of researchers from all over the world.
Along these lines the organisers of the conference will increase the number of joint symposia with other European and World wide operating societies active in the fight against the burden of stroke.
In continuity with the tradition, controversies in diagnosis and management, scientific mini-symposia addressing particularly interesting aspects of treatment and prevention and more generally oriented educational symposia covering the full scope of stroke related interests will be organised.

 

The 7th World Stroke Congress, organized by the World Stroke Organization (WSO), is a landmark event attended biennially by leading medical professionals interested in finding global strategies to combat the second most common cause of death worldwide.

The WSO Seoul 2010 Congress will facilitate the dissemination and discussion of all aspects of stroke and provide a platform for experts to present the latest research.

In the first teaching course of the congress, James Grotta from USA is giving an overview about the recent and the ongoing acute stroke trials. In the same session there are presentations related to the subjects of how to organise acute stroke unit care and thrombolysis in country of low resources in addition to the subject of CT technologies in acute stroke.

There are other teaching sessions and hundreds of papers and research posters which are going to be presented and discussed in the congress. Some of the themes of the meeting are specifically focusing on issues like: clinical stroke syndromes, venous thrombosis syndrome, evidenced- based rehabilitation following stroke, alternative medicine in stroke management, subcortical stroke, intracerebral haemorrhage and advances in Neuroimaging.

The organisers of the session of stroke rehabilitation are planning to discuss the usage of virtual reality as an intervention tool in addition to the subject of computer games and rehabilitation.

For the 9th year running the Welsh stroke Conference has managed to attract the attention of the hundreds of stroke specialists and members of the multidisciplinary teams from Wales and all around the country. The conference which was held on 25th June 2010 in the River Front of Newport has started with a presentation from Professor Steven Cramer about the subject of brain repair after stroke. The speaker is an Associate Professor of Neurology at the University of California, Irvine. His research focuses on brain repair process after central nervous system injury in humans, with an emphasis on recovery of movement after stroke.
The subject of cerebral small vessel disease and its diagnosis and management was the main focus of Dr Mike O’Sullivan lecture. Mike is one of the Neurologist and MRC fellow in Cardiff. His main research interest is in mechanism of cognitive impairment in aged population and its relation to cerebral small vessel disease.

The third lecture in the first session of the stroke conference was about advances in stroke rehabilitation by Professor Robert Teasell from Ontario. The lecturer has edited 4 books and authored over 200 peer-reviewed articles in his field. Professor Teasell is the primary investigator of the acquired brain injury evidence-based review (ERABI) and the spinal cord injury research evidence (SCIRE)) projects.
The main lecture of the conference was given by Professor Jeffrey Saver from California about the subject of future of stroke medicine. He is currently chair of the stroke council of the American heart association. Professor Saver is the principal investigator of a specialized program of translational research in acute stroke.

The 9th Welsh stroke conference has addressed the issue of living with stroke and discussed subjects like: oral health care and visual problems post stroke. Professor Kennedy Lees from Glasgow was speaking about thrombolysing for acute ischaemic stroke and the evidences available so far for the practice in hyperacute stroke care. Professor Keith Muir was lecturing about Neuroimaging for stroke patients and the recent advances in this field. He was a guest speaker few weeks ago in North of Gwent where he was speaking about the latest developments in the field of stem cell in stroke research and management.
The organisers of the conference have chosen few posters about subjects related to stroke service delivery, stroke research and stroke case presentations. The experience of the stroke teams in Wales in using the teleconferencing to facilitate educational meetings across Wales was presented in a poster by Dr. P. Jones and Dr.Tom Hughes from University Hospital of Wales.

Since 1990, the European physicians and scientists are meeting in a conference to discuss their latest research activities in stroke.
The orginsers of the European Stroke conference managed to oragnise a special meeting for the stroke nurses and the allied health professionals working in stroke care. This type of activity was started successfully in 2007.
On 25th May 2010, the 19th European stroke conference is starting with hundreds of papers, drug trials and research posters and presentations from all over Europe and other countries in the world. In fact the representatives to the conference are coming from almost 90 countries giving the feature of an international stroke conference to this 19th European one which is held in Barcelona, Spain for three days.
The main topics for discussion in this European stroke conference are: Acute Stroke, Emergency management, stroke units and complications. Another important topic is the subject of intracerebral/ subarachnoid haemorrhage and venous diseases. Rehabilitation and reorgnisation of service after stroke is a subject which attract good number of presentations and posters in this conference. There is a mini symposium about an update regarding carotid stenosis.
‘www.strokeupdate.co.uk ’ is happy to participate in the European stroke conference on annual basis and share the results of the European stroke trails with the rest of the world.
Read the final programme of the conference here

ESC Final Programme__

-Understand safe practice during thrombolytic therapy for acute stroke
- Recognise situations and approaches to investigation of patients with rarer causes of stroke
- Appreciate the variable presentations of neurological migraine and the role of investigations
- Recognise features of dizziness which do not indicate vascular disease and further investigation
- Awareness of the current training programme for stroke medicine

In the first day of the forum, Professor Kennedy Lees from University of Glasgow, updated the audience about SITS.  The aim of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was to assess the safety and efficacy of intravenous alteplase as thrombolytic therapy within the first 3 h of onset of acute ischaemic stroke. The avialble information confirmed that 6483 patients were recruited from 285 centres (50% with little previous experience in stroke thrombolysis) in 14 countries between 2002 and 2006 for this prospective, open, monitored, observational study.

Professor Lees mentioned that there are 93 medical centres in UK which are participating in thrombolysing stroke patients and in comparison with the rest of Europe the time to needle time is slightly longer for UK patients. Professor Lees concluded that he thinks that the process currently is moving in the right direction although he mentioned that we are still thrombolysing more severely affected patients clinically than the rest of the European colleagues.

Professor Garry Ford was discussing the issue of thrombolysing patients over 80s. He mentioned that the mortality rate for above 80 years old patients following thrombolysis after stroke is at 31% higher than the rest of the patients which stand at 14%. He pointed out that currently a hyperacute research grant is available for at least 8 stroke units in UK to enhance the thrombolysing service.

Nurses stroke forum:

In the first day of the UK Stroke forum there was a session for the stroke nurses and the allied health professionals. In that session Dr. Anne Rowat was outlining the rational for food and fluid needs following a stroke. Dr Ailsa Brotherton was talking in the same session about the PEG feeding : patient carer perspectives.

The forum paid attention this year to the issue of stroke rehabilitation. The first training session in the forum regarding this subject was about life after stroke. The learning objectives are:

-Highlighting key issues contributing to the experience of life after stroke

- Discussing current evidence on programmes designed to support life after stroke using examples from four different programmes of research and practice development.

- Outlining the key gaps in current provision and the potential barriers to participation after stroke, incorporating the stroke survivor’s perspective.

Stroke Rehabilitation

Dr. Kate Radford from University of central Lancashire was talking about Vocational rehabilitation for stroke patients and there was another talk about getting out of the house by Dr Pip Logan. Professor Julie Bernhardt from Australia presented to the forum the latest research results regarding the timing of starting rehabilitation after stroke. She spoke about a new model for rehabilitating stroke patients. The model is combining between the acute service and rehabilitation enabling the physiotherapist and the occupational therapist to perform their tasks whilst the patient is still in acute stroke ward. She mentioned that the advice for the clinicians is to let the rehabilitation team in touch with the stroke patients as soon as it is clinically possible and the patients are haemodynamically stable. Professor Bernhardt as she is the main investigator of AVERT trail (A very early rehabilitation trial for stroke) mentioned that it is a pragmatic trial which investigate the benefit of early rehabilitation on 5 days a week basis for stroke patients. It is an international multicenter trial with few centres in England and Wales participating in recruiting patients for it.

The trainee of BASP and in the second day of the forum has presented their abstracts for their research activities. There was a presentation about inflammatory markers and poor outcome following stroke, reliability of the Modified Rankin Scale and the need for intensive cardiac monitor following a TIA.

The forum has hosted many talented people who presented their new ideas for better stroke and TIA service in their own regions. There was a good opportunity to discuss the ideas between the attendees and the exhibitors in the ideas fair in Glasgow. The forum remembers the important role of the paramedic in TIA, Stroke care. There was a presentation about extending the role of paramedics in early management of TIA and stroke by David Davis from South East Coast Ambulance Service.

]]> http://www.strokeupdate.co.uk/2009/12/4th-uk-stroke-forum-what-can-we-do-to-prevent-strokes/feed/ 0 http://www.strokeupdate.co.uk/2009/07/european-neurological-society/ http://www.strokeupdate.co.uk/2009/07/european-neurological-society/#comments Sat, 18 Jul 2009 20:56:04 +0000 amer http://www.d1037909.cp.blacknight.com/stroke/?p=38 ]]>

The 19th meeting of the European Neurological society includes workshops, teaching sessions, oral presentations and medical posters discussing several subjects related to the Neurological diseases worldwide.

The total number of abstracts submitted to the Scientific Committee of the Nineteenth Meeting of the European Neurological Society was 925 abstracts.
The highest number of abstracts submitted per topic for presentation at the Milan Meeting is in subjects of: Cerebrovascular disorders [164]; Multiple sclerosis: clinical aspects [103] and Dementia/Higher function disorders [71], followed by General neurology [54].
The total number of participants was 2,931 from a total of 86 countries, worldwide.

Stroke prevention: research with changes practice

Dr. Leys from France was the first speaker at the meeting on Monday 22nd June 09.
The objective of the talk is not to make a systematic review, but to focus on a few selected strategies that have changed or will change our practice in managing stroke patients..
Primary prevention trials:
- A meta-analysis of 22 studies showed that smoking doubles the risk of ischaemic stroke. Subjects who stop smoking reduce this risk by 50%. Making public places smoke-free would result in huge benefits.
- A systematic review found hormone replacement therapy to be associated with a small increase in stroke risk.The Women’s Health Initiative trial suggested that this risk is increased only in women with hormone use of 5 years or more.
- Antiplatelet agents reduce risks stroke in patients with non-valvular atrial fibrillation, but warfarin (target INR 2.0-3.0) is more effective than aspirin at reducing stroke, especially in patients who have had a previous systemic embolism (including stroke), over 75 years of age, with high blood pressure or poor left ventricular function. Warfarin was also safe and effective in older individuals. The combination of aspirin and clopidogrel is less effective than warfarin.
Secondary prevention trials
- Antiplatelet therapies reduce vascular events, including non-fatal myocardial infarction, nonfatal stroke and vascular death in patients with previous stroke or TIA. Clopidogrel, and the combination of aspirin and extended release dipyridamole, are slightly more effective than aspirin, but the

re direct comparison did not find any difference between both strategies.

Expanding the opportunities for the treatment of acute stroke

Prof. Henereci talking about the new stroke trials

Regarding the new trials for stroke management and ideas about the feasibility of such trails Professor Hennerici from Germany was speaking at the meeting. He attended the meeting after chairing the 18th European stroke conference in Sweden in May 09.
In contrast to increasingly improving and expanding experimental and clinical research efforts during recent decades, the possibility of therapeutic options is disappointing: regulatory approval for the treatment of acute ischaemic stroke is limited to intravenous tPA in a short time-window with rapidly decreasing, albeit excellent early prognosis, within 90 minutes after onset of symptoms and slowly increasing haemorrhagic complications after 3-6 hours. Obviously, the concept of bench-to-bedside translation (with the exception of revascularisation) challenges our knowledge about the pathophysiology of ischaemic brain injury in man.
Prof. Hennerici mentioned that research is needed to increase efficacy and applicability of thrombolysis by extending the time-window by using new thrombolytic compounds and application, such as sonothrombolysis, hypothermia, or CBF augmentation. Although well-known, acute stroke does not only cause deleterious neurotoxic effects but also necrosis of the complex cellular system forming the blood-brain barrier (BBB) and the neurovascular unit. A better understanding of the mechanisms of the BBB maintenance is a prerequisite to understand its response to focal cerebral ischaemia, the sequence of circulating blood elements leading to inflammation and apoptosis (e.g. activated microglia/microphages and heterogenic leukocytes producing oxygen and nitroxygen radicals ). They play a key role in subsequent post ischaemic inflammation supported by endothelial, glial cells and neurons involving a complex cascade of mediators.
Neuroinflammation aggravates BBB breakdown and neuronal damage, but at the same time and through similar mechanisms and sometimes even identical mediators, confers neural protection and stimulates reorganisation (MMPs and TIMPs). Understanding of these mechanisms may lead to new concepts of support for endogenous neuroprotection and preventive measures using promising candidates to down-regulate ischaemic damage, increase the ischaemic tolerance and stabilise the BBB. Regeneration and repair after stroke needs to be investigated – again research is needed not only with regard to neurogenesis, reorganisation, new vessel formation and repair, but also to design a new model of stroke for experimental studies and a better selection of criteria to identify the appropriate patients for the clinical study, based on the best experimental model.
Screening and management of unruptured cerebral aneurysms

Dr. Rinkel from Netherland mentioned that unruptured intracranial aneurysms are present in around 2% of the population. Main risk factors are female sex, a positive family history, polycystic kidney disease, a previous ruptured aneurysm, increasing age, and smoking, hypertension and alcohol abuse. Unruptured aneurysms may rupture in the near or distant future and sometimes these lesions warrant preventive intervention by means of coiling or surgical clipping. However, in many situations uncertainty abounds, and in many other situations intervention will probably do more harm than good. In these situations follow up imaging to detect growth of the aneurysm is often advised, but data on frequency and effectiveness of this strategy are lacking. Factors that determine the risk of rupture include size and site of the aneurysm, and family history.
In individuals with only one affected first-degree relative, screening is not very efficient or effective. Although patients with no family history and no polycystic kidney disease who have survived an episode of haemorrhage are at increased risk for a new episode from a new aneurysm or from recurrence of the treated aneurysm, screening for new aneurysms can not be recommended in general, but can be considered in patients (especially women) with an initial episode at a very young age and with multiple aneurysms at time of the initial haemorrhage.
Genetic determinants are likely to play a role in the development of intracranial aneurysms.

Cerebral vein thrombosis: from case-series to recommendations

Professor Ferro from Portugal said that dural sinus and cerebral vein thrombosis (CVT) are less common than other stroke types and challenging to diagnose. He focused on recent advances and uncertain issues in the diagnosis and treatment of CVT and how they are reflected in available guidelines. Clinical presentation of CVT varies in different demographic groups (children, women, elderly). Worldwide, there is a global variation of associated conditions and risk factors, reflecting the variability of their prevalence in different world regions. The current diagnostic standard for CVT consists of MR with T2* sequences and angio-MR. Venous CT angiography has probably the same diagnostic accuracy as veno-MR. New MR modalities will be necessary to increase our diagnostic ability of this condition, given the limitations of the current screening methods (CT, D-dimers, transcranial Doppler).
The prognosis of CVT can now be stratified using the validated CVT risk score. Anticoagulation remains the fundamental therapeutic measure. Antiepileptic drugs are recommended in patients with seizures and in those with supratentorial haemorrhagic lesions. Concerning the need for long-term anticoagulation, a trial is planned to compare short vs. long term prescription.

Improving the outcome of cardioembolic stroke with early antioxidant therapy

Oxidative stress has a major role in the pathogenesis of cerebral ischaemia/reperfusion injuries. Since cardioembolic strokes have a high rate of spontaneous recanalisation, antioxidants should have good results in this subtype. In this study the authors evaluated the effect of antioxidant treatment with alpha-lipoic acid (LA) started in the first 24 hours after stroke onset on the outcome of cardioembolic (CE) stroke.
CEs were selected from 2 consecutive series of acute ischaemic stroke patients admitted to the hospital. Each patient had demographic data recorded, the NIHSS score and the Barthel index (BI) evaluated at admittance and discharge. Oxidative stress was assessed by measuring the serum malondialdehyde (MDA) levels with the tiobarbituric acid method at admittance and on days 3 and 7. The control group received treatment according to current guidelines, while the second group received in addition 600 mg of LA intravenously for 7 days.
The study concluded that results that LA administered early after stroke onset diminishes lipid peroxidation, as demonstrated by the decreased levels of MDA in the sera of patients who received antioxidant treatment.

Mumbai Stroke Registry Quality of Life in Stroke Survivors

The authors of this study initiated prospective community based stroke registry in Mumbai, in subjects having first-ever-stroke (FES), to collect data on stroke epidemiology and disability status in stroke survivors from Jan 2005 to Dec 2006.
A well-defined community (H-ward) with verifiable census data was selected, 156,861 people aged over 25years who were eligible were screened. WHO STEPwise approach to stroke surveillance Version 2 was operational protocol. Neurological deficit on admission was recorded by National Institute of Health Stroke Scale (NIHSS) and disability status at 28 days by Modified Rankin Scale (MRS).
The study showed that 456 FES subjects were identified. By 28 days, of 131subjects with mild neurological deficit at onset (NIHSS <5 at onset) 87 made good recovery (MRS 0 to 2) and 3 died (2.2%). Of 149 subjects with moderate deficit (NIHSS 6- 15), 34 showed good recovery (MRS 0-2), 97 (65.1%) had moderate to severe disability (MRS 3 to 5) and 15 (10%) died. Whereas in 70 subjects with severe neurological deficit (NIHSS 16-42), 19 (27.1%) had moderate to severe disability (MRS 3 to 5) and 48 (68.5%) died. In 103 subjects where NIHSS score at onset was not verifiable, by 28 days 23 remained moderate to severely disabled (MRS 3 to 5) and 67 (65%) died. In the latter group CT confirmation of stroke diagnosis was available in 67 of 103(65%) cases; and in majority (82 cases) ischemic stroke was major sub-type.
In MSR mild neurological deficit at onset was associated with good recovery whereas those with severe neurological deficit at onset had poor prognosis in terms of outcome (disability status). In developing countries like India there are difficulties in implementing intensive and immediate treatment on account of: lack of public awareness on warning symptoms, poorly organized ambulance services and non-availability of acute care beds.

Aphasia and watershed cerebral infarction from French team

View from Milan June 09

View from Milan

Stroke Books Exhibiton at Milan Neurology Meeting.