Clinics and Services

Stroke Services

The cerebrovascular service treats adult patients of all ages, with all types of strokes, including those caused by both ischemia and intracranial hemorrhage.

The past decade and a half has seen several major advances in the field of stroke diagnosis and therapy. Major highlights have included: 1) the development of effective thrombolytic agents for acute cerebrovascular occlusions; 2) clarification of the role of Warfarin in stroke prevention; 3) the development of two new effective antiplatelet drug agents; 4) establishment of the role of carotid endarterectomy and stroke prevention; 5) the refinement of new imaging techniques, such as diffusion weighted magnetic resonance imaging and magnetic resonance angiography, which, by allowing rapid and non-invasive evaluation of acute stroke and the brain vasculature, have greatly advanced our understanding of stroke pathophysiology.

Despite these significant advances, many problems and challenges in cerebrovascular disease remain. These include: 1) the failure of the neuroscience community to develop effective neuroprotective agents for acute stroke; 2) exploration of the potential of new antithrombotic therapies; 3) fine-tuning of the role of thrombolytics; 4) the role of endovascular therapy for extracranial, and perhaps intracranial atherosclerosis; 5) the role of extracranial-intracranial bypass in symptomatic carotid occlusion; 6) continuing lack of any effective therapy for intracerebral hemorrhage. In addition, the general public remains relatively uninformed about the warning signs, and the availability of effective therapies, for stroke; to some extent this nihilistic attitude remains among physicians as well.

Clearly there is much more work to be done.

The Cerebrovascular Service of the Department of Neurology at UAMS interacts extensively with physicians and other healthcare professionals in the departments of Vascular Surgery, Neurosurgery, Cardiology, Neuroradiology, Rehabilitation, and Speech/Swallowing Disorders -- all of whom make important contributions to the care of the patient with threatened or established stroke.

Current research efforts in the department include participation in multi-center randomized clinical trials of stroke interventions. UAMS was a center in the PROACT II study, which established the efficacy of intra-arterial prourokinase in middle cerebral artery occlusion. This study has been completed, but the drug has not been approved by the Food and Drug Administration.

UAMS was one of the first clinical centers to become active in the Carotid Occlusion Surgery Study (COSS) study. This multi-center, NIH-funded trial involves patients with symptoms distal to an occluded internal carotid artery and elevated oxygen extraction fraction in the affected hemisphere as determined by PET scanning. Eligible patients are randomized to EC-IC bypass surgery plus best medical therapy, or to best medical therapy alone, and followed for up to 5 years.

In concert with Neuroradiology and Vascular surgery, UAMS stroke Neurologists are also participating in the Carotid Revascularization Endarterectomy Stenting Trial (CREST). This multi-national, NIH-funded study is comparing the efficacy of carotid angioplasty and stenting with that of carotid endarterectomy in patients at risk for ischemic stroke. The University of Arkansas site has been one of the most active in this trial.

For questions concerning stroke diagnosis and management contact Dr. James Schmidley or Dr. Salah Keyrouz at (501) 686-5135. For questions about clinical trial participation contact the department's nurse coordinator, Ms. Deborah Fewell (501) 603-1223.

Please visit the American Stroke Association for more information.

Informational Articles:

Recommendations for the Establishment of Primary Stroke Centers - JAMA

Long-term Outcome After Thrombolysis in Telemedical Stroke Care - Neurology

The Burden of Cardiovascular Disease in Arkansas - Arkansas Department of Health

Publications:

SCHMIDLEY JW.  Ten questions on CNS vasculitis.  The Neurologist 14: 38-40, 2008.

SCHMIDLEY, JW.  Central Nervous System Angiitis.  Butterworth-Heinemann, 2000.

SCHMIDLEY JW, Beadle BA, Trigg L. Co-occurrence of CADASIL and isolated CNS angiitis. Cerbrovasc Dis 19: 352-4, 2005.

SCHMIDLEY JW.  “CNS Vasculitis,” in Daroff RB, Bradley WG, Fenichel G, Jankovic J (Eds): Neurology in Clinical Practice, Fifth Edition.  Butterworth-Heinemann, 2007, in press.

SCHMIDLEY JW.  No substitute for a tissue diagnosis of primary CNS angiitis. Neurology Network Commentary 3: 299-301, 1999.

SCHMIDLEY JW.  Vasculitis involving the nervous system.  Contemporary Neurosurgery 18 (23): 1-6, 1996.

Amiri M, SCHMIDLEY JW, Fink LM, Nazarian SN.  Is testing for inherited coagulation inhibitor deficiencies in young stroke patients worthwhile?  Clin Neurol Neurosurg, 102: 219-22, 2001.