Dr Paul Syme BScHons, MBChB, MD, FRCPUK
Consultant Physician (Lead Stroke Physician, Borders
General Hospital)
Part-time Senior Lecturer, Department of Geriatric
Medicine, University of Edinburgh
Principal Investigator of the Scottish Borders Stroke Study
Formerly - MRC Clinical Scientist, University of Oxford (
Professor George Radda Quantifying NMR Spectroscopy). MRC travelling
Fellowship, University of Nice (Dr Jacques Pouysségur)
Dr Paul Syme is a Part-time Senior lecturer in the Department with a full
time clinical commitment in the Borders General Hospital (BGH), a busy District
General Hospital near Edinburgh. He is the principal investigator of the
Scottish Borders Stroke Study (SBSS), which is the first “ideal” incidence study
to have been carried out in Scotland. Incident cases were collected from
October 1998 for two calendar years and a further year follow up for mortality.
SBSS analysis is still on-going and the main findings are due to be published
soon. Funding for this study was obtained from the Chief Scientist Office and
Chest Heart and Stroke Scotland. As part of the SBSS analysis Dr Syme has
developed a First-ever
stroke incidence (.ppt
file, 446KB) and
bed-model (.pdf
file, 151KB), which allows an accurate estimate of community FES numbers
and Stroke Unit beds. These models have been endorsed by the
Scottish Executive. He is currently working with the Information and
Statistics Division of Scotland analysing trends in Scottish stroke incidence to
develop a stroke risk model, which will aid identification of both environmental
and genetic causes of stroke in Scotland. As part of the SBSS, stroke patient
blood samples were obtained for genetic analysis. This has led to a
Borders/Grampian collaboration on the Genetics of Stroke with Dr Mary Joan
Macleod, Senior
Lecturer, University of Aberdeen.
Dr Syme has been on the SIGN guideline development group
of
Hypertension in
older people, SIGN guideline No. 49, the Immediate Discharge document No. 65
and is the chair of the next Acute Stroke SIGN
guideline which will replace guidelines No. 13 and 14. He was also a
member of the Stroke Services Project Group for NHS Quality improvement Scotland
(Clinical standards
~ March 2004 Stroke services: Care of the patient in the Acute Setting).
Dr Syme formerly worked as an MRC Clinical Scientist at the
University of Oxford on the quantitation of NMR spectra under Professor Sir
George Radda. Over the last three years his
interest in spectral analysis has been used to develop Transcranial Doppler
Ultrasound (TCD) as a bed-side
diagnostic tool to aid both the diagnosis and treatment of all cerebrovascular
cases. He has examined several hundred patients using single-gated TCD and has
found it to be an invaluable “stethoscope
for stroke physicians”
(.pdf file, 2.20MB).
As a result of extensive TCD spectral analysis, he has developed a new TCD
technique for targeting and treating small vessel occlusion. A patent has
been applied for this technique involving the NHS and Scottish Health Innovations
Ltd.
Dr Syme's experience suggests that TCD can detect small
vessel occlusion in the form of “small vessel knock”(SVK) and that targeting SVK
can result in complete clinical recovery even after a considerable time window.
If confirmed, this would challenge current concepts on the ischaemic penumbra
(view article online). Dr Syme’s experience
also suggests that SVK can detect occlusion of small vessels when the
MRI is negative (.pdf file, 1.95MB).
This could allow the detection and treatment of small vessel occlusive disease,
which is the main cause of stroke and vascular dementia. Collaborative,
randomised control trials are planned to test these findings and to explore the
mechanism behind the action of ultrasound.
A video record suggesting clinical recovery during TCD
insonation has been obtained in over 40 patients.
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Recent Publications
The use of transcranial doppler ultrasonography as a 'cerebral stethoscope' for
the assessment and treatment of acute stroke. Syme PD. (2006). JRCollPhys (in
press)
Are cardiac syndrome X, irritable bowel syndrome and reflex sympathetic
dystrophy examples of lateral medullary ischaemic syndromes? Syme PD. (2005).
Medical Hypotheses 65, 145-148
Community-based stroke incidence in a Scottish population: the
Scottish Borders Stroke Study. Syme PD, Byrne AW, Chen R, Devenny R, Forbes JF.
(2005). Stroke 36 (9), 1837-43
Transcranial Doppler ultrasonography detection of small vessel knock in
MRI-negative stroke–like deficits (Poster presentation Vancouver June 2004, 5th
World Stroke Conference).
View poster online - .pdf file,
1.95MB
Detection of Small Vessel Knock using transcranial doppler
ultrasonography - implications for the ischaemic penumbra and the
treatment of small vessel occlusive stroke. Syme PD. Advances
in Clinical Neurosciences 4, 4, 2004, 28-31.
Link to online article
Five further cases of spontaneous recanalisation during transcranial Doppler
insonation - is this enhanced endogenous thrombolysis? Syme P. J Cerebrovas Dis
16 (suppl 4) 47 (Poster presentation ESC 2003). View poster
online - .pdf
file, 2.20MB
Worldwide comparison of age-standardised stroke incidence with true age-adjusted
stroke risk. Syme P, Byrne A, Chen R. J Cerebrovas Dis 16 (suppl 4) 13 (Poster
presentation ESC 2003). View poster online - .ppt
file, 446KB
Death Certification errors in the Scottish Borders Stroke Study (SBSS)
(Abstract). Clinkscale H, Syme P. J Cerebrovas Dis 16 (suppl 4) 11 (Poster
presentation ESC 2003)
Estimating stroke unit bed numbers for Scotland: the Scottish Borders Stroke
Study Poisson bed-occupancy model (Abstract) 2003 Syme P, Litster S, Mckinnon K.
J Cerebrovas Dis 16 (suppl 4) 10 (Poster presentation ESC 2003).
View poster online - .pdf file, 151KB
Comparison of worldwide first-ever-in-a-lifetime (FES) stroke incidence risk:
implications for current and future stroke incidence (Abstract). Syme P, Byrne A,
Chen R, Finlayson AJ. Cerebrovas Dis 16 (suppl 4) 2 (Oral presentation ESC 2003). View poster online - .ppt
file, 446KB
The community-based incidence of stroke in a Scottish population, the Scottish
Borders Stroke Study (SBSS) (Abstract). (2003). Syme P, Byrne A, Devenny R, Chen R,
Forbes J. J Cerebrovas Dis 16 (suppl 4) 2 (Oral presentation ESC 2003)
Scottish Borders stroke study final report. CSO 2002
Comparison of early and delayed respondents to a postal health survey: A
questionnaire study of personality traits and neuropsychological symptoms. Chen
R, Wei L, Syme PD. (2003). Eur. J. Epid 18195-202
Scottish Borders Stroke
Study
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