Natalia Rost, MD, MPH, is fascinated by the complex mechanisms behind the damage to the brain caused by strokes.
Here is this complex organ, an impossibly ornate bundle of fat and nerves and blood vessels, yet when specific functions are lost after a stroke, the area of brain loss that's responsible can be readily identified. And more importantly, it can heal and be healed.
“It's kind of beautiful in a poetic sense,” Dr. Rost said recently from her office at Massachusetts General Hospital, where she is associate director of acute stroke services.
Dr. Rost's work in unraveling the mysteries behind stroke damage to the brain helped her win the 2012 AAN Michael S. Pessin Stroke Leadership Prize.
The prize is for “emerging neurologists” with a “passion for learning and expanding the field of stroke research.”
“What I've done so far in my career is try to put as much energy, as much enthusiasm (as possible) in trying to figure out why some people go on to have strokes and why others don't,” she said. “And if they happen to have a stroke, how is it that some get away with minimal injury and have better outcomes, and others are devastated?”
Dr. Rost's research ranges from the genetics of stroke to neuroimaging to prediction of outcomes. She contends that using multiple tools to attack the same research question provides an effective and efficient approach to solving complex neurological problems.
Her main line of inquiry now is the role of white matter hyperintensity — or leukoaraiosis, non-specific abnormalities in the brain's white matter that seem to worsen as people age — in predicting stroke and its severity.
It's “a footprint of damage to the brain that exists prior to an acute event,” Dr. Rost said. “Those people who have greater burden of the pre-existing disease actually are more likely to proceed to have a stroke as opposed to transient ischemic attacks. Similarly, their strokes are larger and the clinical outcomes are worse.”
Dr. Rost is using an original methodology to calculate the volume of white matter hyperintensity by putting MRI scans through special software.
So far, she and her fellow researchers have only been studying patients who have had actual strokes. But she is hoping to expand the work to other patients, too, including those getting MRIs for non-emergency reasons.
“If we do that in advance we may actually be able to prevent some strokes from happening,” she said. “Future studies will need to identify therapeutic strategies that would be effective for stroke prevention in these types of patients. Or, if strokes do happen, maybe they'll be smaller and the outcomes will be better.”
Her work is not limited to neuroimaging, though. At this year's AAN meeting, she presented a paper examining stroke patients and cocaine use. The study concludes that cocaine use affects a wider range of stroke victims than previously thought, with a population that is more highly educated than previously reported. The suggestion is that better awareness and wider toxicology screening would be beneficial.
Dr. Rost — who was born in Russia and came to the US for college and her medical training — was one of the lucky ones when it came to medical school — “I've almost always known what I wanted to do.”
She chose to follow Carlos Kase, MD, in his stroke clinic at Boston University School of Medicine. He introduced her to Framingham Heart Study principal investigator Philip Wolf, MD, with whom she worked on a stroke-related Framingham study.
Dr. Rost was captivated by the way the Framingham study approached prediction of cerebrovascular disease from every conceivable angle.
After the study with Dr. Wolf was published, “I got a bug,” she said, more compelled than ever to delve into the factors that lead to stroke. Having completed her neurology residency and stroke fellowship at Massachusetts General Hospital, she remains fascinated.
Dr. Rost began coursework for an MPH at the Harvard School of Public Health in 2008, finishing last year. The statistics and epidemiology training will only make her research more rigorous, she said. And coursework in marketing and management will help with motivating people and with the flow of her research program.
“I think the results are only as good as your ability to formulate the research question, to apply correct methodology, and to analyze the results,” Dr. Rost said.
She may be deeply devoted to the academic nature of her work, but sees herself, above all else, as a caretaker of patients who is not averse to 4 a.m. calls.
“If there's anything we can do for them at any time of the day or night, that would be much more important than getting extra hours of sleep,” she said. “No matter how complicated it could be to organize a particular test or deliver a particular therapy, we could never imagine what kind of stress these acute stroke patients are going through and what kind of trauma their loved ones are living through as well. My mission, both as a clinician and as a scientist, is to do whatever it takes to offer them every opportunity to do well.”
For more about the Michael S. Pessin Stroke Leadership Prize, visit http://bit.ly/II5WpP.