Winter 1996 Volume 5, Number 1
Doctors have needed effective drugs for brain attack, and powerful new compounds are in clinical trials. Some --such as t-PA, the first found effective in stroke --aim at swiftly restoring blood supply to affected areas; others seek to moderate the storm of toxic chemicals unleashed by damaged and dying brain cells; still others harness substances that the brain itself uses to protect and repair its cells. But satisfactory trial of these compounds has its own problem, one that must be worked out, or it will follow the drugs to the bedside. That is: Brain attack is highly variable from patient to patient; the precise risk to the brain must be defined before a treatment can be applied with confidence.
Walter Koroshetz and Greg Sorenson at Massachusetts General Hospital have applied a new method to accurately identify ischemic brain injury in the emergency setting and to monitor the outcome of treatment. It combines two types of magnetic resonance techonology: a technique that shows very early ischemic changes in the mobility of brain water (DWI) and a technique to identify brain regions that do not receive normal blood flow (hemodynamic imaging). By clearly showing the attack in all its stages and after treatment, this new method will both reduce the number of patients needed for clinical trials and, in practice, greatly improve doctors' ability to evaluate patients' progress at critical stages.
