In Context

34 www.thelancet.com/neurology Vol 8 January 2009

Profi leVladimir Hachinski: a pioneer in the fi eld of strokeVladimir Hachinski, a pioneer in stroke and vascular dementia, found his calling as a neurologist fortuitously. During a residency in internal medicine, Donald Baxter, one of his mentors, asked his opinion on a complex neurological case. When examining the patient, Hachinski noted a deep ulcer with no pain sensation on the sole of the patient’s left foot. His presumptive diagnosis was neurosyphillis, which turned out to be correct. He then acquired an instant reputation for diagnosing neurological problems—a reputation that he felt called upon to justify.

“I was intrigued by neurology in medical school, but I didn’t think that I was smart enough”, he recalled; however, his curriculum vitae, which runs to 72 pages, shows he was wrong about his capabilities. Hachinski is currently professor of neurology and distinguished university professor at the University of Western Ontario in London, Ontario, Canada; editor-in-chief of Stroke; founding member and current chairman of the International Society for Vascular Behavioral and Cognitive Disorders; fi rst vice-president of the World Federation of Neurology since 2006; author of 17 books; and author and coauthor of more than 600 book chapters, scientifi c papers, editorials, and other scholarly publications.

Early in his neurological residency, Hachinski became interested in the interactions among the brain, its blood supply, and the heart, and the implications for cognition, stroke, and sudden death. His interest in stroke no doubt sprang from when he was 12 years old, and his 33-year-old mother had a stroke. Fortunately, she recovered fully and continues to enjoy a healthy and independent life.

The main areas of Hachinski’s research are vascular cognitive impairment, stroke, and brain–heart interactions. He coined the term multi-infarct dementia and developed the Hachinski ischaemic scale, which is thought by cardiologists and stroke experts to be the best and most widely used clinical method to distinguish between degenerative dementia and multi-infarct dementia. With John W Norris, he established in Toronto the fi rst specialised stroke unit for the urgent clinical treatment and systematic study of stroke. He then established a stroke unit in London, Ontario, and his trainees have founded stroke units all over the world. Hachinski and Norris co-designed the Toronto stroke scale to assess the severity of acute ischaemic stroke. He collaborated with Robert Cote to design the Canadian neurological scale, a way for neurologists and non-neurologists to measure stroke-related neurological defi cits.

Harold Merskey, who is emeritus professor at the University of Western Ontario, has worked with Hachinski since the 1980s and is a close personal friend. Merksey says, “Vladimir is a very impressive man with a very impressive

record. He has made great contributions to organising knowledge and understanding of all forms of vascular dementia.”

When asked which personal characteristics led to his success, Hachinski cites a willingness to work hard, the pursuit of effi ciency, enjoyment of working with other colleagues, and love of a challenge. During his internal medicine residency, he worked under Douglas Cameron, professor of medicine at McGill University in Montreal, Canada, whose high standards intimidated many residents. Hachinski, however, rose to the challenge. He too sets high standards. “I believe that anything one is doing can be done better.”

These traits were apparent when he was a teenager in Venezuela, where he grew up after he and his family fl ed Ukraine to escape persecution by Stalin. One requirement for high school graduation was to complete a course in manual training but Hachinski was not good at building things with his hands. He convinced his teacher to let him design a bookcase to house a set of encyclopedias that had been lying on the fl oor of his homeroom, but to have it built by students who were better carpenters. Together they created an elaborate bookcase that won him the highest mark in the class.

Balancing his work and personal lives is a challenge for Hachinski. A friend once called him a workaholic, which caused him to take a good look at his life. He does not believe he is a workaholic because he leaves his work at work. Sundays have always been for family time; however, Saturday daytimes are reserved for paperwork and catching up with medical journals.

Hachinski is most proud of his trainees. “I take great pleasure in the accomplishments of all the people I have trained. They are now on fi ve diff erent continents, and many have become prominent,” he said. “I feel so privileged. I was lucky because I was given opportunities, and I like to do that for others. I know that my research is relevant, and the work of my former students will bear fruit in the future.”

His teaching legacy is his unique approach to patients and problem-solving. “Everything we do can be improved. We just need to quantify what we are doing and then fi gure out how to do it better”, he states.

Hachinski’s current research interests focus on the identifi cation of risk factors that are common to stroke and Alzheimer’s disease, the prevention of stroke, and the delay of onset of Alzheimer’s. “I hope to see more research on this in the near future,” he comments. With such a prolifi c record, we can expect many future advances from him and his research team.

Alice Goodmanagoodman1@hvc.rr.com