1. Stroke Research in East Kent Prevention and Treatment Present and Future Dr Tom Webb Consultant Neurologist and Stroke Physician EKHUFT June 2014

2. 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

3. 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

4. Vascular damage to the brain 86,000,000,000 2,000,000/ min die after stroke Brain ages by 4 years every hour untreated

5. ‘Frequent, dangerous, expensive…’ Commonest cause adult disability Major cause of mortality £3 -£8 bn annual cost to UK

7. TIAs - An opportunity to intervene Rothwell P et al, Lancet, 2007. 370(9596): p. 1432-42.

8. TIAs - An opportunity to intervene Rothwell P et al, Lancet, 2007. 370(9596): p. 1432-42.

9. Risk factors we can treat TIA/ Stroke

10. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis

11. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis

12. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis CMBs

13. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs

14. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?

15. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ??

16. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ?

17. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ?

18. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ? ?

19. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ? ?

20. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ? ? ?

21. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ? ? ?

22. Risk factors we can treat TIA/ Stroke Hypertension Atrial Fibrillation High Cholesterol Diabetes Obesity Smoking Atherosclerosis OSACMBs ?? ? ? ?

23. What are we studying?

24. Diagnosis in East Kent TIA clinic

27. A unique resource 365/365 (33%) Consultant review (33%) MRI for all patients (16%) 1500 TIA/ minor stroke patients 2011-13

29. 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

30. 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

31. 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?

32. CMBs Work with UCL research group Blinded review of East Kent MRs Correlation with clinical features

33. Obstructive Sleep Apnoea Nocturnal hypopnoea, apnoea and hypoxia Up to 25 % of men affected Increased risk of cardiovascular disease… … and stroke?

34. OSA and Stroke - Correlation or causation? Over 60 % of stroke have OSA Stroke may cause OSA (but TIAs unlikely to…) Complex relationship of risks

35. 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?

36. Other ideas? Atrial fibrillation? ABCD of TIA and Stroke? Relevance of MRI abnormalities

37. Mortality from Stroke is falling…

38. Thank you