In a series focusing on medical specialties, the BBC News website meets Dr Anil Sharma, who talks about stroke management.
Clot busting drugs are extremely effective
In this branch of medicine doctors deal with the treatment and rehabilitation of patients who have had strokes.
WHAT IS YOUR JOB?
I am a consultant physician specialising in stroke. I am based at University Hospital Aintree, Liverpool.
Basically I look after people who are referred after a TIA (transient ischaemic attack) - mini stroke, or a stroke.
Strokes can be caused in two ways - a blockage in an artery in the brain by a clot. This is called an ischaemic stroke.
Less common is a rupture of an artery causing a brain haemorrhage - this is called a primary intra-cranial haemorrhage.
WHAT IS THE MOST COMMON CONDITION?
Stroke is relatively common.
If we get to see somebody within three hours we can give them clot busting (thrombolytic) drugs to break up the clot and re-open the artery, thus ensuring that the degree of brain damage is minimised and brain that is deprived of blood is salvaged.
WHAT IS THE MOST COMMON PROCEDURE?
There are two main procedures, firstly, the use of thrombolytic drugs for suitable patients and secondly sending patients who have had TIAs and have severe disease of the carotid arteries for carotid endarterectomy - an operation to clear out the carotid artery.
With regard to thrombolytic drugs at the moment we are trying to make the public more aware of the importance of stroke and getting help as soon as possible so we can start the drugs.
We want people to recognise the signs of stroke and we tell them to look out for FAST signs:
Because stroke does not cause pain, people are sometimes not aware of how dangerous it can be.
We should call it a 'brain attack', rather than stroke to warn people of just how urgent it can be.
The risk of having another stroke within 24 hours without the drugs is very high.
We need to see people as quickly as possible because we can only give the thrombolytic treatment within three hours from the onset of stroke.
I would suggest people should by-pass their GP if they think they have had a stroke and get an ambulance straight to a specialist centre where they can be considered for appropriate treatment.
Not everyone is suitable for this treatment, e.g. those who have had a haemorrhage can not have it.
So everyone needs to be assessed urgently and this can take half an hour to an hour, including a brain scan - so speed is important.
The most important thing is to manage acute stroke patients in a multi-disciplinary acute stroke unit, as there is good evidence to support that treating patients with stroke in these units saves lives and reduces disability.
WHAT IS THE HARDEST THING ABOUT YOUR JOB?
The hardest thing is bringing about change.
Changing the public and professional perspective on stroke and getting patients to appropriate centres.
These centres need to have full facilities for the care of stroke patients.
A brain scan of someone who has had a stroke
The most effective way to deal with stroke is to minimise brain damage with appropriate care, including drugs and attention to preventing complications.
This leads to reduction in rehabilitation costs and savings for the NHS.
At the moment there are only a few specialist centres like ourselves and most of these are not able to operate 24 hours a day in terms of thrombolysis.
We hope that our unit will be able to deliver a 24/7 service by the end of this year.
WHAT IS YOUR MOST SATISFYING CASE?
A local GP developed acute stroke following cardiac catheterisation and lost his speech.
With effective thrombolysis he made a complete recovery within 24 hours and returned to work full time as a GP.
WHY DID YOU CHOOSE THIS SPECIALITY?
When I was a registrar, 30 years ago, we used to do ward rounds down the old fashioned Nightingale wards.
We used to start off at the top and the stroke patients used to be at the bottom and the ward round just used to sort of peter out by the time we got to them and there was little we could do for them.
I wanted to be able to do something to help them.
IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?
No not at all.
WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?
I think in the early days when cardiology was a bit of a poor relation, like stroke is now, I might have chosen that.
I wanted to do something about which I could make a difference to people for whom little was being done at the time.
HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?
I think in the future we are going to see the time window when we can use clot busting drugs increasing.
There will be changes to how the clot can be treated. There are a number of people for whom the intra-venous drugs do not work, and in the United States these can be identified and the drugs can be put straight into the artery.
There are also inventions to corkscrew out the clots if they still don't disperse.
I see the future being the emphasis becoming on more specialised centres with patients being taken straight in to them for specialist treatments rather than general hospitals.
CV - Dr Anil Sharma
1968: Qualified as a doctor at Punjab University, India
1992:Fellow of Royal College of Physicians FRCP (London)
Present:Consultant Physician and Clinical Director, Department of Medicine for the Elderly
Divisional Medical Director, Department of Medicine, University Hospital Aintree at Aintree Hospital