Overview of current and future research opportunities in

Stroke and Vascular Disease

David Yates

who knows very little about these topics

Extended remit

Stroke and Trauma (TBI & SCI)*pathophysiology

*epidemiology

*systems development

*cerebral protection

*initial care

*rehabilitation

Large variably deprived populationSMR above average for Stroke and TBI. ?for SCI

Potential 5* SBS Inflammation & Epidemiology

National / European Trauma Database?Links with CV and DM databasesInterest in disability scoringMild TBI / Psychology / EpilepsyGood immediate access to acute patients

Colleagues consulted

Hope

Fiona Lecky

Mike Horan

Pippa Tyrrell Preston

Aprajay Golash Southport

Clive Glass Walton

- - - - -

Stroke (Pippa Tyrrell)

Basic Science collaboration with SBSPhase three trials

Both need good clinical infrastructure

Problems with funding when inadequate staff to recruit patients and follow up in acute phase

?role for Intercern Clinical Trials Unit

Stroke

Health Services Research

- effectiveness of care pathways

(GM guidelines group)

- value of discharge booklet Pain

effect on rehabNeglect; drop foot; dysphagia

Stroke - Potential Co-operation

Anil Sharma - Aintree on IL1ra DMCDavid Bowsher - Liverpool PainEd Gamble - Liverpool PainAudrey Bowen (psychology)- SALT NeglectEd Gamble - UHSM

Stroke summary

Infarct limitationPain Specific complicationsPathwaysOutcome analysis

Injury (Aprajay Golash)

Neuronal regenerationReformation of synapsesOutcome measuresLink with Southport

SCI Clive Glass / Bakul Soni / Pradip Sett

Incidence in NWOutcome measures

- physical & psychological

(Koln group)Optimising patient pathways

(including initial care)

Injury (Lecky, Hopkins, Warhurst, Carlson, Childs & Dark)

Early haemodynamic changes

(systemic v. cerebral)

Inflammatory responses

(+ Large scale clinical trial of MP)ThermoregulationGut barrier function

(systemic injury BBB)

Mild TBI / psychology / brain markersEpidemiology / outcome analysisPatient pathways

Links with geriatrics (Horan)

InflammationMetabolic consequences of stroke

Other players

Arpan Guha (neuro ICU Walton)

BMJ: “pre-hospital scoring system for trauma”

Others at Walton?

Common themes

An acute groupModulation of inflammationBBB / tight junctionsMarkers / early diagnosisPatient pathways / standard settingOutcome analysisLarge scale clinical trials