Our longest-serving faculty member, Dana DeWitt, MD, the Medical Director for the Inpatient Neurology Service at the University Hospital, shares her personal journey, notable changes in stroke care throughout her tenure, and her vision for the future of vascular neurology.
Exploring the Evolution of Stroke Care: A Seasoned Neurologist’s Perspective
Stroke care, a dynamic field at the intersection of neurology, internal medicine, cardiology, hematology, vascular surgery, and rehabilitation medicine, has witnessed remarkable advancements in recent years. As our understanding of strokes has deepened, so too have the approaches to diagnosis, treatment, and prevention. To gain valuable insights into the ever-evolving landscape of stroke care, we had the privilege of speaking with our longest-serving faculty member, Dana DeWitt, MD, the Medical Director for the Inpatient Neurology Service at the University Hospital and a member of our department’s Vascular Division. In our conversation, Dr. DeWitt shared her personal journey, notable changes in stroke care throughout her tenure, and her vision for the future of this critical field.
What initially sparked your interest in stroke care, and how has that evolved over your time with the Neurology Department?
I found stroke to be a very interesting subspecialty of neurology that not only included the brain but also internal medicine, cardiology, hematology, vascular surgery, and rehabilitation medicine. My mentor in stroke always said, “You learn neurology one stroke at a time.” What he meant by that is that strokes occur from blockages in different size blood vessels and in different parts of the brain, so the stroke presentation identifies the way different parts of the brain work.
What significant changes or advancements have you witnessed in stroke care during your tenure, and how have they impacted your practice?
When I began my training, there were new ways of diagnosing stroke. MRI had been developed as a way of identifying acute and chronic stroke. However, when a stroke occurred, there was no real treatment acutely. The main option was rehabilitation.
Now there are acute therapies that have improved outcomes tremendously. These include thrombolytics (tPA and TNKase), which initially had to be given in a three-hour window, though now that window is four and a half hours. Then, the development of thrombectomy has significantly changed outcomes in patients with large vessel occlusions. The techniques and catheters used continue to evolve, and our ability to quickly and effectively remove clots keeps improving.
In addition, identifying stroke etiology has improved and secondary stroke prevention has changed with the results of clinical trials.
How has the public's perception and understanding of stroke care changed over the years?
There is a big emphasis on education. FAST (an acronym for face, arm, speech, and time) is a method of helping patients understand when it is necessary to call EMS.
As I mentioned, there used to not be any acute stroke therapies and nothing to do if patients delayed coming to the hospital. Now we need to educate the patients so they know there are acute therapies that can clearly make a difference in outcomes. Through TeleStroke networks, patients can also go to their closest hospital, even if it is small, and a stroke neurologist can be contacted to give recommendations.
In addition, stroke prevention education is very important. Controlling hypertension, diabetes, and cholesterol, as well as emphasizing tobacco use cessation, are topics that need to be discussed with patients.
What do you envision for the future of stroke care? Are there any areas of research or technological advancements that you believe will shape the field in the coming years?
There are multiple ways stroke care can be developed. Further identifying the timeframe for thrombectomy and which patients are eligible is one. Improving clot removal methods is another.
In addition, there are things like identifying additions or improvements to thrombolytic therapies; developing neuroprotective agents that can be given at stroke onset to improve outcomes; increasing our understanding of the appropriate secondary stroke prevention, both in the immediate post stroke period and in the long term; and enabling earlier diagnosis and treatments through processes like imaging and beginning treatments in ambulances.
Stroke care has undergone remarkable changes over the years, and Dr. DeWitt’s insights highlight the continuous pursuit of refining stroke care. The future holds promise for advancements in stroke care through research and technological innovations, ultimately leading to better outcomes for patients affected by this life-changing condition.
L. Dana DeWitt, MD, has been with the University of Utah for nearly 20 years. She is Medical Director for the Inpatient Neurology Service at the University Hospital. She is also a member of the Brain Attack Team and interprets transcranial Doppler. Dr. DeWitt has had the honor of receiving awards such as the Best of Boston Magazine’s Top Docs for Women, Consumers’ Checkbook Top Docs, and Best Doctors in America 2005–2008.
