When Moses Pimentel found himself collapsed on his bathroom floor one Sunday morning last June, a stroke wasn’t the first ailment that came to mind. He even wondered why his wife called an ambulance.
Paramedics conducted a rapid assessment on the fit, healthy, 47-year-old Saanich parks staffer, and found telltale left body paralysis. They rushed him to the care of Dr. Andrew Penn, a neurologist at Victoria General Hospital.
Penn and his staff at VGH, the nucleus of stroke care for Vancouver Island, found Pimentel’s underlying heart defect that triggered the stroke, but it was that rapid response that was crucial in preventing lasting damage. Pimentel regained control of his body the same day, was out of hospital in six days and back to work in two months.
“Without that rapid assessment who knows what would have happened? I have a physical job and a family to take care of,” Pimentel, who manages invasive species in Saanich parks, said at VGH on Thursday. “I’m not sure what I would have done.”
Recognizing that quick and early detection of strokes can save lives and medical resources, the Vancouver Island Health Authority and Genome B.C. have launched a $10 million project that will give emergency room doctors a tool for nearly instantaneous diagnosis of a minor stroke, called a transient ischemic attack (TIA).
“If you think of stroke as an earthquake, a TIA is the rumbling before the earthquake,” Penn said during the project announcement at VGH.
About 10 per cent of minor strokes lead to full-blown major strokes within two days, but diagnosing a TIA is difficult and pricey. Less acute medical problems such as dizziness and severe headaches can look like a TIA, but it can take considerable medical resources to separate the mimics form the real thing.
“There are about 30 mimics of TIAs for different (medical) conditions,” Penn said. “The full meal ticket is expensive. To investigate a TIA costs thousands of dollars involving dyes, radiation, CT scans or MRIs.”
In 2004, VIHA allowed Penn to set up a stroke rapid assessment unit at VGH, which in turn allowed him to amass the largest stroke database in the world from 11,000 patients across Vancouver Island. About 4,000 blood samples from that database will allow the University of Victoria's Genome B.C. Proteomics Centre at the Vancouver Island Tech Park to crunch through reams of data, all to find the signal set of proteins associated with a TIA.
If researchers can nail down the pattern of proteins released by the brain during a TIA event, diagnosing a TIA could become a relatively simple blood test, rather than time-consuming brain scans. The project, the largest in VIHA's history, expects to see results within four years.
"VIHA took a gamble and set up a TIA unit to rapidly assess a TIA before a stroke hit. The project was a great success … in two years we’ve saved some 150 strokes on Vancouver Island," Penn noted. "But with that success came failure – we were flooded with patients, but about half weren’t TIAs. They might be migraines or seizures or other things that might not need urgent care (in the ER). We needed a blood test to differentiate those who needed urgent care.”
Dr. Brad Popovich, the chief scientific officer for Genome B.C., said it's hard to overstate the importance of Penn's database of Vancouver Island stroke patients. It holds more stroke information than any other major medical centre in the U.S. and Europe due to VIHA's centralized system, and was key to unlocking $10 million to get quick TIA detection off the ground.
“The funding for this project addresses critical and immediate needs," Popovich said. "Stroke is the No. 1 cause of adult disability and stroke patients are the leading users of long term care in Canada. This (TIA test) will be better, cheaper, faster … this will bring tangible results to British Columbians and beyond."
VIHA estimates rapid TIA detection technology will help doctors prevent 4,000 strokes per year in Canada, cut risks for patients due to the use of radioactive dyes during the diagnosis, cut costs to the health system in terms of patient care, and allow for better use of MRI and CT scan machines.
At VGH, the stroke assessment unit is set to expand into the hospital's former emergency wing (the new emergency centre opened in 2009), which will give the stroke team six exam rooms and four offices, up from two rooms now.
“Health professionals want to improve stroke care. A lot of people don’t understand the devastating affects on the lives, livelihood and families of stroke victims," said VIHA board chair Don Hubbard. "That is why this research is so important.”