By Katarzyna Krzywicka

Follow on Twitter: @kat_krzywicka

Class of 2022 in Birmingham

25th ESO Summer School – a very special week in Birmingham

The 25th ESO Stroke Summer School took place on 5-9 September 2022 in Birmingham, England and was an unforgettable experience – not only because it was a first post-pandemic live (!) Summer School, but also due to very special events taking place in the United Kingdom throughout these five days (announcement of a new Prime Minister, passing of Queen Elisabeth II and appointment of a new King).

In early September, as 50 (aspiring) neurologists from 24 countries gathered in the halls of the University of Birmingham Medical School, the city of Birmingham topped the ranking with a number of stroke enthusiasts per square kilometre. Birmingham, also called “The Heart of England”, temporarily became “The Brain of England” and thanks to fantastic efforts of the organising team – Dr Phil Ferdinand, Professor Christine Roffe, Dr Indira Natarajan, Dr Sissi Ispoglou, Dr Jason Appleton, Dr Don Sims, Dr Girish Muddegowda, all participants of the Summer School enjoyed a delightful mixture of high level stroke education, networking and socialising.

First day was initiated by Professors Gary Ford and Iris Grunwald reminding us about everything we have learned and should know about thrombolysis and mechanical thrombectomy in acute ischaemic stroke. Afterwards, we worked in small groups discussing the importance of venous thromboembolism prevention, oxygen and blood pressure in stroke patients. From Dr Adam Low we learnt about safety considerations of anaesthesia during thrombectomy (always inform the anaesthetist if you expect a complex patient!). Dr Ranjan Sanyal entertained us with an interactive (and very useful!) lecture and provided us with simple algorithm for an often challenging diagnosis in dizzy patients. Dr Sissi Ispoglou triggered a discussion about atypical presentations and underdiagnosis of stroke and Dr Neena Bodasing reminded us of the importance of low-threshold HIV testing and advantages of an opt-out approach. The evening social programme kicked off with a delicious Indian curry dinner (a real Birmingham specialty!).

On a second day, Professors Hanne Christensen and Nikola Sprigg discussed the impact and management of intracerebral haemorrhage. Particularly the difficulty of attaining high quality data and high numbers of patients in intracerebral haemorrhage studies have been highlighted as current problems in the field. An important message was that time is brain – also in intracerebral haemorrhage patients – so do not slow down once you see blood! Consequently, a debate between Dr Adrian Parry-Jones and Dr Jason Appleton on whether elevated blood pressure should be intensively lowered in acute intracerebral haemorrhage patients yielded some unexpected results in voting among the participants – although everyone seemed to agree it should be lowered – the question was – how intensively. Professor David Werring introduced us to cerebral amyloid angiopathy and microbleeds and Mr Edward White took us on a journey from a neurosurgeon’s perspective – arguing that that the guidelines should not be seen as sanctity but that criteria for surgical intervention should be tailored to specific cases. Dr Samer Al-Ali showed us the stroke world from a neuroradiologist’s perspective, and presented a number of interesting cases. Professors Thompson Robinson and Rustam Al-Shahi Salman discussed the role of anti-platelet therapy in both ischemic and haemorrhagic strokes. Professor Joanna Wardlaw introduced us to the small vessel disease – reminding us it is a highly prevalent, important cause of cognitive impairment and very much a dynamic disease. Dr Linxin Li focused on in increased incidence of a young stroke and its possible causes and the scientific part of the day ended with Professor Anita Arsovska giving a comprehensive overview of stroke prevention in women. Evening dinner took place in an Italian restaurant with countless delicious dishes and ended with a luxurious cheese platter.

Third day gave platform to the number of international speakers, also the ESO Executive Committee Members to share their clinical and research interests. Professor Georgios Tsivgoulis gave us an extensive overview of the state of the art of stroke care and frontiers for thrombolysis or thrombectomy (138 slides in 25 minutes challenge?!). Professor Thorsten Steiner gave us perspectives on what future holds for intracerebral haemorrhage. Professor Peter Kelly showed us highly inspiring molecular and imaging approaches to studying inflammation in secondary stroke prevention. Dr Diana Aguiar de Sousa gave us a comprehensive overview of the knowledge about cerebral venous thrombosis (also after COVID-19 vaccination) and future perspectives for this relatively uncommon but highly relevant disease. Professor Martin Dichgans introduced complex but fascinating concepts of genetics in stroke (among others, the use of GWAS) and Dr Else Sandset took us on a personal journey and gave us early career tips (say yes to the opportunities when you are young). Second part of the day was opened by Professors John Camm and Robert Hatala who introduced atrial fibrillation and cardioembolic strokes from a cardiologist’s perspective. Dr Jukka Putaala  discussed the young stroke studies with focus on the cardiac causes of stroke. The day was crowned with a royal steak dinner topped off with an elegant sticky toffee pudding (an absolute highlight according to some).

The focus of the fourth day was life after stroke. Important topics were rehabilitation of the motor function of the limbs – introduced by Professor Nick Ward, management of spasticity – discussed by Dr Sachin Vashistha and balancing the exercise post-stroke to achieve better outcomes (importance of strength and aerobic exercises) – by Dr Ulrike Hammerbeck. After the break, from Dr Joseph Kwan we learned about the holistic approach to stroke care and about how little we know about almost miraculous effects of exercise and diet, we discussed fatigue, depression and anxiety in stroke patients with Professor Gillian Mead, and studied late rehabilitation, reintegration and return to work after stroke (physicians unfortunately rarely encourage patients to return to work…) with Professor Avril Drummond. We also learned from Mr Brin Heliwell about how it is to be a stroke patient – he also gave us recommendation about how we should make our work more meaningful for our patients. After lunch, Professor Silke Walter showed us the progress of work on the Mobile Stroke Unit and the challenges associated with introducing them (price and geographic landscape, just to mention two). Professor Christopher Price explained the pre-hospital stroke assessments, including the newest portable diagnostic technology to help identify large vessel occlusion. Lastly, Dr Deb Lowe, Dr David Hargroves and Dr Ajay Bhalla introduced us to a an integrated approach to Stroke Delivery Networks, Stroke National Audit Program and taught us how to bring change in the stroke field. Last evening was celebrated in the Jewellery Quarter of Birmingham, and dancing to an outstanding live band lasted until late night hours.

Fifth day focused on the challenges ahead in the stroke field. Together with Professor Hugh Markus we studied the vertebral artery disease, with Professor Terry Quinn – the often overlooked topic of cognition in stroke and about the unmet need of post-stroke cognitive screening testing. Professor Serefnur Ozturk took on a highly relevant topic – inequalities in stroke care among migrants and refugees. Professor Craig Smith shared the considerations about stroke and COVID-19 infection. Although the risk of stroke is small, once it occurs, it appears to be more severe, more likely with multiple large vessel occlusions. The summer school was concluded by passionate Professor Christine Roffe with a talk on clinical benefits of the hyper-acute stroke unit.

All in all, we certainly learned a lot about the current stroke practices and newest research directions, interacted with brilliant stroke experts from around the world (also learned that many of them have attended an ESO summer school earlier in their careers) and became even more enthusiastic about the field. We met fellow young stroke physicians and spent fantastic five days in Birmingham (which has more canals than Venice!).

It was a highly successful summer school with a well-rounded programme which surely will remembered for many years to come.

Thank you to everyone who made it possible!