Working together, brilliant neurosurgeons and neurologists at UT Southwestern detect, treat and prevent cerebral vascular disease.

For years UT Southwestern has offered hope for thousands of patients whose lives hang in the balance. Long considered one of the most advanced stroke and neurosurgical sites in the U.S., the medical center and its renowned neurosurgeons and neurologists have made it their collaborative mission to detect, treat and prevent cerebral vascular disease in patients who are fighting to reclaim their minds and bodies after a blood vessel that transports nutrients and oxygen to their brain is blocked or bursts.

In 2010 the Joint Commission certified UT Southwestern University Hospital as a Primary Stroke Center, a coveted distinction for health care institutions fostering coordinated stroke care for patients. In 2011 the program will be established as a comprehensive stroke center, which recognizes the hospital as a primary referral destination with highly specialized, interdisciplinary teams capable of taking on the most complex cases from across the country. This unique collaborative model is one of the first targets for the clinical center for neurosciences now being developed at UT Southwestern.

“We not only have launched a very aggressive, cutting-edge effort to treat stroke, we are leaders in new approaches to treatment,” said Dr. Mark Goldberg, chairman of neurology and neurotherapeutics. “Our program is unique in its depth and the quality of its collaboration with specialists in complementary fields.”

About 83 percent of strokes are caused by blockages and are called ischemic strokes. The remaining 17 percent are known as hemorrhagic strokes and are caused by a ruptured aneurysm or blood vessel. When either occurs, part of the brain begins to die from lack of blood flow.

“Strokes and high blood pressure can be caused by any number of factors – some manageable, such as smoking, and some not, such as heredity. Likewise, a patient’s rate of recovery can hinge on things such as overall health and the length of time between stroke onset and arrival at the hospital. Because every patient’s treatment is dependent on all of these elements and more, it is critical to have an interconnected team that can be mobilized at a moment’s notice,” said Dr. Goldberg, holder of the Linda and Mitch Hart Distinguished Chair in Neurology and director of the Beatrice Menne Haggerty Center for Research in Brain Injury and Repair in Strokes.

Sudden warning signs for strokes include numbness or weakness in the face, arms or legs, especially on one side of the body; confusion or difficulty speaking or comprehending; vision problems; trouble walking or loss of balance and coordination; and severe headache with no known cause.

“Time and expertise in stroke care are critical factors that dramatically affect the outcome for stroke victims,” said Dr. Mark Johnson, associate professor of neurology who heads the cerebrovascular/stroke clinic and who is one of the stroke team leaders. “Having a trained stroke response team and the dedicated technology and medicine available in the emergency room allow us to identify and assess suspected stroke patients rapidly. The more quickly and accurately we can diagnose the patient’s condition, the sooner proper treatments can begin.”

LEADING THE WAY

Specialists at UT Southwestern have pioneered the development of some of the most advanced and effective stroke and brain aneurysm procedures and technologies now used. In 1989 researchers at UT Southwestern refined a fast-acting drug called tissue plasminogen activator  (tPA), which can rapidly dissolve blood clots in patients with ischemic stroke, greatly reducing the risk of mortality or severe disability. Now used universally for stroke treatment, the drug must be administered within four and a half hours of the attack, although an overwhelming majority of patients do not get to the hospital or receive a diagnosis in time to receive it.

Cerebral aneurysms – a bulging, weakened area in the wall of an artery feeding the brain – rupture in about 30,000 people in America every year, often with devastating results. Burst aneurysms, which account for about 20 percent of strokes, kill or permanently disable more than 60 percent of their victims.

For neurosurgeons, the challenge is to catch the aneurysm before it bursts. With early detection through MRIs, they can find and apply lifesaving surgical strategies to the malformations.

Neurological surgeons at UT Southwestern have performed more pre-emptive surgeries to prevent aneurysm-induced stroke than any medical center – more than 2,500 over the last decade.

“One of the great advantages that we have at UT Southwestern is that so many options are available to our patients,” said Dr. Jonathan White, associate professor of neurological surgery and radiology and holder of the Birsner Family Professorship in Neurological Surgery. “Not only are we equipped with first-rate neurologists who can handle acute stroke in patients when they are seen in the emergency room, we also have an entire team of neurosurgeons and endovascular ‘interventionists’ who can go to the source of the problem using the most advanced technology available anywhere.”

UT Southwestern patients have access to an array of high-tech tests, including arteriograms, in which interventional neuroradiologists like Dr. Phillip Purdy insert a tiny catheter into an artery in the leg, feed the tube through the body to the brain and insert dye that allows blood vessels in the brain to be visible.

Endovascular surgery, a rapidly growing medical subspecialty, is so new its name is still evolving. It is often called “endovascular neurosurgery,” to reflect the new neurosurgical procedures that are now possible because they are performed inside (endo) the blood vessels (vascular).

Regardless of what name is used, Dr. Purdy, director of neuroradiology, is a leader in the field. He has invented five devices – for which UT Southwestern holds the patents – that have increased the success with which physicians slip a spaghetti-thin catheter into the patient’s groin and thread it to the brain, enabling injection of drugs to dissolve blood clots, isolate threatened vessels and treat other abnormalities without the more traditional and more invasive neurosurgery.

“The advancement in the use of catheters for stroke in the past decade has been one of the field’s greatest developments,” said Dr. Purdy, who was instrumental in the development of the innovative neuroangiography expansion and suite at UT Southwestern University Hospital – Zale Lipshy, to which referring physicians throughout North Texas who have neither the angiography training nor the necessary facilities send their patients.

“The precision with which we can now treat stroke is remarkable,” said Dr. Purdy, who holds the Orien and Jack Woolf, M.D., Distinguished Chair in Neurosurgery and Neuroangiography.