When it comes to detecting strokes, the brain is a bit of a black box.

On Vancouver Island, chances are a person who has sudden slurred speech or an intense headache will be referred to Dr. Andrew Penn at Victoria General Hospital. ThereB次元官网网址檚 also a chance the person will be sent home with an undetected underlying condition that could lead to a deadly or debilitating stroke.

Giving emergency room doctors the tools to quickly detect strokes and their precursors, transient ischemic attacks (TIAs), is an intensely difficult problem. Penn, a neurologist and the medical lead for Island HealthB次元官网网址檚 stroke rapid assessment unit, is leading the charge to crack open the brain, figuratively, to tease out those warnings that something has gone haywire.

B次元官网网址淚f you think about a heart attack, the symptoms are well known to the public and ER docs B次元官网网址� chest pains and shortness of breath. There are a narrow range of things that mimic that,B次元官网网址� Penn says.

The problem is that symptoms of strokes and TIAs have dozens of mimics B次元官网网址� such as dizziness, shortness of breath, migraines B次元官网网址� and figuring out the real thing requires time consuming and expensive scans using radiation, CT or MRI machines.

B次元官网网址淔or strokes, the public doesnB次元官网网址檛 know the symptoms, and thereB次元官网网址檚 a one in nine chance the doctor has had stroke training. There are no blood tests, no ECGs, only high-end imaging,B次元官网网址� he says. B次元官网网址淪o how do we support (ER doctors) when they have a full tilt job? ItB次元官网网址檚 a tough job diagnosing brain stuff. If the brain goes wrong, what does that look like?B次元官网网址�

To answer that question, Penn is overseeing a four-year $10 million project, the largest research project in Island HealthB次元官网网址檚 history, to revolutionize early stroke detection in Canada. Announced March 2013, itB次元官网网址檚 taken a year to get the pieces in place to fully wed research and clinical care, while satisfying B.C. intense medical privacy laws. ItB次元官网网址檚 a significant culture shift, Penn says.

B次元官网网址淢edicine tends to go into crisis intervention, putting out fires,B次元官网网址� he says. B次元官网网址淲e know we have a system full of problems and arenB次元官网网址檛 delivering as nearly good care as we can. We are gearing up to fix that.B次元官网网址�

In January, PennB次元官网网址檚 stroke unit and a partner hospital in Calgary started collecting the 4,000 blood samples from people exhibiting TIAs and strokes. The University of VictoriaB次元官网网址檚 Genome B.C. Proteomics Centre at the Vancouver Island Tech Park will use powerful computers to weed out a common set of proteins in those blood samples that signal a stroke event. ItB次元官网网址檚 not certain that such a signal exists.

B次元官网网址淭hat is the $10 million question,B次元官网网址� said Dr. Brad Popovich, chief scientific officer with Genome B.C., the main funder of the project. B次元官网网址淭hat said, it wouldnB次元官网网址檛 be funded if there wasnB次元官网网址檛 a rational basis to believe there is a signal.

B次元官网网址淲hen patients come in, they could be having a stroke for a lot of reasons, there is a lot going on to try and find the common threads between groups. It takes a lot of patients and a lot of patience to sort through that data.B次元官网网址�

Penn, 59, a resident of Metchosin who attended medical school at Cambridge University at age 19, set up the stroke rapid assessment unit at VGH 10 years ago and with it the groundbreaking database of every stroke or TIA victim on Vancouver Island. Now with 12,000 patient histories in the database, itB次元官网网址檚 considered the most comprehensive in the world.

From that database and using heady algorithms, Penn has amassed a set of common words and phrases used by stroke or TIA patients in describing their symptoms. That is being turned into an iPad tool for ER doctors to ask a series of questions to gauge the likelihood a patient is suffering a stroke or TIA. Penn expects that tool to be rolled out at VGH relatively soon.

B次元官网网址淭he great part about this is the impact this will have on the Island. The computer-based tool will have an impact right away,B次元官网网址� Popovich said.

Penn says even if the protein analysis doesnB次元官网网址檛 yield the precision theyB次元官网网址檙e aiming for, the four years of work will still improve rapid and early detection of strokes, a major factor in saving lives and reducing physical disabilities.

B次元官网网址淲e are setting ourselves a useful goal, but we donB次元官网网址檛 have to hit the moon. It will still be useful if we can take those 700 (patients) and filter them down to 100 or 50,B次元官网网址� he says.

B次元官网网址淲eB次元官网网址檒l do a better logistics job B次元官网网址� weB次元官网网址檒l have the right person giving the right treatment at the right time.B次元官网网址�