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in Stroke:
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About
the Author:
Dr Paul Syme is a Part-time Senior Lecturer with a full
time clinical commitment in the Borders General Hospital, a busy
District General Hospital 33 miles south of Edinburgh, UK. He is
the principal investigator of the Scottish Borders Stroke Study
which is the first “ideal” incidence study to have been
performed in Scotland. SBSS analysis is still on-going and the main
findings are due to be published soon. Funding for this study was
obtained from the Chief Scientist Office and Chest Heart and Stroke
Scotland. He has developed a First-ever stroke incidence and bed-model
which allows an accurate estimate of community FES numbers and Stroke
unit beds which has been endorsed by the Scottish Executive. He
is currently working with the Information and Statistics Division
of Scotland analysing trends in Scottish Stroke incidence to develop
a stroke risk model which will aid identification of both environmental
and genetic causes of Stroke in Scotland. In collaboration with
Dr Mary Joan Macleod, Senior Lecturer at Aberdeen University is
currently working on a Borders/Aberdeen collaboration of the genetics
of stroke. He has been on the committee of the SIGN guidelines and
has been asked to chair the next Acute Stroke SIGN guideline. He
was a member of the recent Quality Improvement Scotland Stroke guideline.
Dr
Syme
was previously an MRC clinical scientist in Oxford University working
on ion transport in Hypertension and quantitation of NMR spectroscopy
under Professors Grahame-Smith and George Radda. This involved the
analysis of Fourier transformed spectra using rubidium as a potassium
substitute. He was also a French exchange Fellow with Professor
Jacques Pouysegur in the University of Nice working on the transgenics
of the sodium/hydrogen exchanger. With this background and despite
a heavy clinical load, he has maintained an interest in spectral
analysis and over the last three years has developed Transcranial
Doppler Ultrasound (TCD) as a bed-side diagnostic tool to aid with
the diagnosis and treatment of all cerebrovascular cases. He has
examined several hundred patients using single-gated TCD and has
found it to be an invaluable “stethoscope for stroke physicians”.
He has set up a TCD clinic in the Neurovascular clinic at the BGH,
which is one of the first one-stop Neurovascular clinics in Scotland.
He has developed a new technique using TCD for targeting and treating
small vessel occlusion. A patent has been applied for this technique
involving the NHS and Scottish Health Innovation. He has found that
TCD can detect small vessel occlusion in the form of “small
vessel knock”. Targeting SVK can result in complete clinical
recovery over a considerable time window which is a very exciting
finding in stroke. This challenges current concepts on the ischaemic
penumbra. SVK can also detect occlusion of small vessels when the
MRI is negative. This could allow the detection and treatment of
small vessel occlusive disease which is the main cause of stroke
and vascular dementia. Randomised control trials are planned to
test these findings and to explore the mechanism behind the action
of ultrasound. This is likely to involve a German/USA/UK collaboration.
Video evidence of clinical recovery during TCD insonation has been
obtained in over 40 patients. One of Dr Symes’ patients has
agreed to be shown on the web. She is a 58 year old woman who presented
with sudden onset of hemianaesthesia, mild hemiplegia, tinnitus
and vertigo. SVK was identified and targeted insonation resulted
in opening of a small vessel occlusion at 72 mm through a transforaminal
window. This was associated with full clinical recovery.
You can find out more, and see Dr Syme's poster from the World Stroke
Congress, on his web site at http://www.geriatric.med.ed.ac.uk/paul_Syme.htm
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