Alan Barber

Update on Stroke

After years of therapeutic nihilism, there are new treatments for stroke and transient ischemic attack (TIA) shown to be of benefit in clinical trials. In ischemic stroke patients, thrombolytic therapy with tissue plasminogen activator (tPA) reduces death and disability in those presenting within 4.5 hours after symptom onset. Patients treated with tPA are 1/3 more likely to be normal or independent at three months compared with those not receiving tPA and clinical benefit is seen in one patient for every seven treated.  Randomised controlled trials have clearly shown benefit of stroke units over care in a general ward. Only 18 patients need to receive care in a stroke unit to prevent one from dying or being dependent at one year. Care in a stroke unit is not more expensive than care in a general ward and the introduction of a stroke rehabilitation unit in Christchurch resulted in an eight day decrease in length of stay. In recent years it has become clear that the prognosis following transient ischemic attack (TIA) is worse than previously realised. Between 20-25% of TIA patients will have a stroke, myocardial infarction or vascular death in the first three months with half of the stroke risk occurring in the first 48 hours. The ABCD2 score is a risk stratification score based on age (A), blood pressure (B), clinical features (C), duration (D) and diabetes (D) and can identify those people most likely to have a stroke. The ABCD2 score ensures that high risk TIA patients are admitted to hospital where up to 80% of strokes can be avoided.

Biography: Professor Alan Barber is a neurologist at the Auckland City Hospital and is the Neurological Foundation of New Zealand Professor of Clinical Neurology.  He trained at Otago University and carried out his neurology training in Christchurch and Auckland.  He then completed a PhD at the University of Melbourne where his thesis examined the place of new magnetic resonance imaging (MRI) techniques in the selection of ischemic stroke patients for new acute stroke therapies.  He returned to New Zealand in 2001 where he leads the Auckland City Hospital Stroke Service.  His research interests continue to focus on MRI in stroke.