Professor David Werring - Honorary Secretary
I am a professor of clinical neurology and honorary consultant neurologist at the Stroke Research Centre, UCL Institute of Neurology, Queen Square, and the National Hospital for Neurology and Neurosurgery (NHNN), University College Hospitals (UCH) NHS Foundation Trust. I contribute to delivering hyperacute and acute stroke care, and run a specialist clinical service and research program in intracerebral haemorrhage and cerebral small vessel disease. My projects include randomised controlled clinical trials and observational (clinical and neuroimaging) studies of cardioembolic stroke, cerebral microbleeds, intracerebral haemorrhage, subarachnoid haemorrhage, and cerebral amyloid angiopathy. I am Chief Investigator of the BHF-funded OPTIMAS (OPtimal TIMing of Anticoagulation after Stroke) trial investigating early oral anticoagulation in ischaemic stroke associated with atrial fibrillation; and of the Stroke Association-funded PROHIBIT-ICH (PRevention Of Hypertensive Injury to the Brain by Intensive Treatment in IntraCerebral Haemorrhage). I am head of the research department of Brain Repair and Rehabilitation at the UCL Queen Square Institute of Neurology. I am chair of the Association of British Neurologists Stroke Advisory Group, Stroke Specialty Lead for the NIHR North Thames Clinical Research Network, member of the board of directors of the European Stroke Organisation, recent member of the National Institute for Health and Care Excellence (NICE) Stroke Guideline Committee, and member of the Editorial Boards of the European Journal of Stroke and Practical Neurology. I am Chair-Elect of the UK Stroke Forum, the largest multidisciplinary stroke conference in the UK.
Stroke and me
My interest in stroke began as a junior house officer in the early 1990s. I noticed that people with heart attacks were treated urgently and transferred to the coronary care unit for specific treatment, while people with stroke were admitted to general medical wards and had no specific interventions. If they had a brain scan it was often delayed for many days. There was a feeling that stroke was not a treatable disease, and not much optimism about prospects for treatment – although I do remember helping recruit patients to the International Stroke Trial of acute antithrombotic therapy. I felt that things needed to improve and had an idea that I might one day specialise in stroke.
I began my training in neurology in the mid-1990s at Queen Square, but at this time there was very little interest in stroke, which was not really considered a neurological disease. On the advice of trusted mentors (David Marsden, Alan Thompson, Ian MacDonald) I did a PhD in brain imaging, mainly in multiple sclerosis, using advanced MRI scans including diffusion weighted sequences. Around this time, in the late 1990s it became clear that diffusion-weighted MR imaging was an extraordinarily powerful diagnostic test for acute stroke, and could also reveal in exquisite detail the consequences of injury to the smallest blood vessels in the brain (both ischaemic and haemorrhagic tissue damage).
It was also around this time (early 2000s) that stroke was being established as a separate specialty, and evidence had begun to emerge about successful acute treatment including intravenous thrombolysis. I decided that this was a great time to go into the specialty of stroke medicine and, thanks to a Stroke Association clinical fellowship, I was able to spend a year learning about the care of stroke patients and undertaking some research. Using some of the skills I had developed in my PhD studies, I was able to do some of the first studies looking at cerebral microbleeds and their influence on cognitive function and bleeding risk. I was hooked on the idea of trying to be a clinical academic in stroke neurology.
I was lucky to be able to include some stroke specialty work in my first consultant (general) neurologist post at Watford and Queen Square, though initially much of my work was in the care of inpatients and outpatients with general neurological problems. Alongside this busy clinical work, which I very much enjoyed, I continued to develop my interest in cerebral small vessel disease, with particular emphasis on bleeding in the brain and how to understand and prevent it. Just as my research was getting really interesting the Department of Health funded the “new blood” Senior Clinical Lectureships which, together with a Stroke Association project grant, and support from mentors including Martin Brown, gave me the opportunity to work as a clinical academic in stroke at Queen Square, and begin to build an independent research team. I became particularly interested in cerebral amyloid angiopathy, a common cause of brain haemorrhage and dementia that at the time was not really on the radar for most neurologists or stroke physicians.
I feel privileged to have had the opportunity to contribute to such a rapidly developing a and exciting specialty. In particular it has been very satisfying to be involved in developing a new hyperacute stroke unit at University College hospital, and to see the increased interest in small vessel disease including the treatment of and prevention of intracerebral haemorrhage. And in the last few years the advent of mechanical thrombectomy has transformed the care of people with the most severe ischaemic strokes.
Although clinical stroke work can be demanding and intensive, the variety and interest is extraordinary, as is the satisfaction of seeing many stroke patients improve and recover. In parallel, academic stoke research has provided an opportunity to work with many talented researchers from all over the UK and the world. I have been lucky to be able to develop many friendships and collaborations. It has been especially exciting to see the growth of the NIHR research network which has allowed many researchers in the UK to undertake collaborative research at many sites on a scale that would have been almost unimaginable in the past.
I have been involved in BASP for many years (initially on the Scientific Committee) and have enjoyed seeing the organisation develop under several inspiring Presidents. I am looking forward as Secretary to helping our team to deliver the BASP strategy and serving the brilliant UK stroke clinical and research community.
I lead a stroke research team at the UCL Stroke Research Centre, and am always interested to hear from young clinicians or budding researchers who would like to work in this field with our team.