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Liv-Hege Johnsen defended her PhD thesis with the title "Intracranial artery disese in the general population. The Tromsø Study" on June 18, 2024

The members of the evaluation committee were professor Mona Beyer, Institute of Clinical Medicine, University of Oslo, docent Ola Nilsson, Dept. of Clinical Sciences, Lund University, Sweden, and assoc. professor Rune Sundset, UiT The Arctic University of Norway.

Intracranial aneurysms (IAs) and intracranial artery stenoses (ICAS) are diseases of the brain's arteries that can cause stroke. Data on the prevalence of both IAs and ICAS in Western populations is limited. In her PhD-project Liv-Hege Johnsen studied the prevalence of these two conditions in an MRI study of 1878 adults aged 40-84 years who participated in the population-based Tromsø Study.

The prevalence of IAs with maximum diameter ≥2 mm was 6.6%. Depending on the definition in terms of size and location, the prevalence ranged from 3.8% for intradural aneurysms ≥3 mm to 8.3% when both intra- and extradural aneurysms ≥1 mm were included. The higher prevalence observed in this study indicate that the risk of subarachnoid hemorrage in patients with unruptured aneurysms is lower than previously thought.  

The prevalence of ICAS ≥50% was 6%. There was an independent association between ICAS and age, male gender, hypertension, hyperlipidemia, current smoking, higher body mass index, and diabetes mellitus. ICAS was associated with presence of cortical brain infarctions, lacunes in the thalamus, periventricular white matter hyperintensities, and brain atrophy. The relatively high prevalence may suggest that the impact of ICAS is stronger than previouly assumed and may be a target for primary prevention.

Congratulations, Liv-Hege!

Medical Research Programme student Elisabet Danielsen has received a Fulbright student scholarship to the USA.

Her research year abroad will take place in the school year 2024-2025, where she be a student at the Department of Neurosurgery at Harvard University. During her stay, she will continue her work on her PhD project on operative treatment for degenerative cervical myelopathy, aimed at improving prognostic modelling and patient outcomes for this condition. 

Congratulations, Elisabet!

The Norwegian Medical Association’s Quality Price for the specialist health services was awarded to the eSTROKE project on May 28, 2024

The price was given to project leader and intensive care nurse John Helge Flage at Nordland Hospital and senior researcher Maren Ranhoff Hov at Oslo University Hospital (OUS) and Stiftelsen Norsk Luftambulanse (SNLA).

SNLA and OUS has previously conducted a study called ParaNASPP where the eSTROKE concept and a specially developed app was being used by paramedics in the pre-hospital stroke care. Nordland Hospital Trust (NLSH) has to together with SNLA implemented the results from this research in its pre-hospital service. 

 Two members from the Brain and Circulation Research Group, Ida Bakke, PhD student at UiT and advisor at NLSH, and Maria Carlsson, assoc. prof. at UiT and senior consultant at NLSH, has had central roles in the development and implementation of eSTROKE.

 The eSTROKE project is aimed at optimalization of the pre-hospital phase of stroke care and involves a stroke education programme, implementation of a standardized stroke scale examination (NIHSS; National Institutes of Health Stroke Scale) by paramedics and of an eSTROKE app. As the first hospital in Norway, NLSH has implemented eSTROKE through systematic education and training of the pre-hospital ambulance and helicopter services. The digital solution has been further developed to include direct transfer of the paramedic hospital report to the patient’s digital hospital record via the ambulance telephone.

 «It is wonderful and a great achievement that eSTROKE has received The Norwegian Medical Association’s Quality Price for an interdiciplinary project between primary and secondary care as well as between departments, clinics, two health regions and SNLA”, says Ida Bakke.

Previous results from ParaNASPP and the eSTROKE concept showed that this improved the detection of patients with mild (minor) strokes, meading that more patients were correctly identified as stroke patients. eSTROKE will now be implemented at the University Hospital of North Norway and in several other hospitals in Norway.

Melinda Roaldsen opened the Presidential Symposium Award & Large Clinical Studies session at ESOC 2024. In her talk, Melinda shared her personal experience as a stroke survivor and talked about the importance of maintaining hope and dreams.

Melinda talked about how her life changed completely from one moment to the next when she as a young stroke researcher was struck down with stroke 7 months earlier. From being an active young stroke researcher and Chief Operations Officer for the Stroke Action Plan for Europe in ESO, her life was now focused on being able to talk and walk again. She urged the audience to have high hopes and dreams for their patients. 

Melinda also took part in an ESOC TV interview presenting highlights from the conference.

A comment about Melinda's presentation can be found here.

Read more about Stroke Action Plan for Europe

The first results from a feasibility study from the Decentralized pre-hospital thrombolysis of stroke project were presented at the Norwegian Neurological Association’s Annual Conference in Oslo on March 13th.

The purpose of the projects was to assess the feasibility of a novel cockpit solution for remote-control of CT-scanners at a decentralized medical centre (DMC) for diagnosis and thrombolysis treatment of acute ischemic stroke patients. Senior consultant at UNN Susanne Ingebrigtsen presented the results at the conference. The project is led by assoc. professor Linn Steffensen.

The innovation project involves the following steps

• initial clinical assessment performed on site by paramedics
• novel cockpit remote-control system for CT-scanning at the DMC, operated by radiographers at the referral hospital
• real-time video/audio-communication for clinical assessments by paramedics at the DMC guided by stroke specialist at the referral hospital
• treatment decision made by stroke specialist at the referral hospital
• administration of intravenous thrombolysis by nurse at the DMC

The initial results show that the time from symptom onset to thrombolysis treatment (onset-to-treatment-time) and time from arrival to the DMC to thrombolysis (door-to-needle-time) were similar at the DMC and at stroke specialist center. The use of helicopter transportation was reduced compared to prior to the project start-up.

Dr. Ingebrigtsen concluded the cockpit solution with remote-controlled CT scan and real time video communication between paramedic and the stroke referral center is feasible and may be a realistic way to increase access to rapid thrombolytic treatment to ischemic stroke patients. This could be an alternative for  timely delivery of thrombolysis in less densely populated areas.

Agnethe Eltoft and Maria Carlsson presented stroke treatment updates at the 8. National Stroke Conference in Oslo Feb 15-16, 2024

Agnethe Eltoft gave an update on current evidence on thrombolysis for acute ischemic stroke. 

The lecture included topics such as tenecteplase vs. alteplase and thrombolysis in wake-up stroke, partly informed by results from the TWIST trial.  

The prognosis for patients with intracerebral hemorrhage (ICH) is poor compared with ischemic stroke. In previous publications based on data from the Tromsø study, Maria Carlsson and colleagues found stable time trends in short- and long- term mortality rates in ICH patients during the last decade. This underlines  the need for better treatment strategies for these patients. At the 8th National Heart & Brain Conference in Oslo, she held a talk on updated treatment strategies for patients with acute ICH, including the bundle of care approach.  

Tonje Melum defended her PhD thesis "Aspects of brain health and pain tolerance in a general population” 

PhD candidate Tonje Melum defended her thesis on February 15, 2024.

In her research, Tonje Melum studied the relationships between pain tolerance and the volume of gray matter in the brain, cognitive function and previous stroke. The work was based on data from the The Tromsø Study, where MRI of the brain, cognitive testing, and experimental pain assessments were done in 1870 particpants of the 7^th survey. This provided a unique opportunity to examine these relationships in a general population. Pain tolerance was measured by the cold pressor test, where the participants are asked to keep their hand and wrist in a cold-water bath (3 degrees Celcius) for as long as they can or until a maximum time (106 or 120 seconds)

The results showed that arger total gray matter volume was associated with higher pain tolerance. The effect sizes were largest in regions of the brain that are known to be commonly activated by painful stimuli in functional studies. Likewise, higher scores on cognitive tests were associated with longer tolerance. Stroke was associated with lower pain tolerance. The findings have possible clinical implications, as patients with stroke or other brain diseases affecting gray matter volume or cognitive function might be more sensitive to or have more difficulty coping with pain. 

The members of the evaluation committee were professor Luis Garcia-Larrea, Lyon Centre for Neuroscience (CRNL), INSERM and Claude Bernard University Lyon 1, France, professor Cecilie Røe, Department of Clinical Medicine, University of Oslo and associate professor Sissel Løseth, Department of Clinical Medicine, UiT. Professor Sigrid Brækkan was the chairperson of the dissertation.

The thesis is available here.

Congratulations, Tonje!

Photo, from left to right: Prof. Luis Garcia-Larrea (inserted, participated online), prof. Sigrid Brækkan, PhD Tonje Melum, prof. Cecilie Røe and assoc. prof. Sissel Løseth