Manitoba neurologist takes on global gaps in stroke care

Meet Dr. Nishita Singh: neurologist, assistant professor at the University of Manitoba, Harvard graduate, future stroke leader with the World Stroke Organization, and member of Mission Thrombectomy 2020+. In 2023, she became the Heart & Stroke and Research Manitoba chair in clinical stroke research – the first in the province. Part clinician, part advocate, Dr. Singh has a vision: improving stroke prevention while addressing global disparities in treatment. “I’m extremely passionate about equitable access to care,” she says. 

First-hand past experiences have influenced her fierce drive today. “During my medical school days, I was a treating physician in rural Maharashtra, India. There I saw the profound impact that stroke can have on people and their families. Treatment options were scarce, and resources were limited. It was devastating.” 

“In my second year of internal medicine residency, I was working in Mumbai at one of the busiest government hospitals in the province. We had a patient come to the hospital at 2:00 a.m. with a stroke. Because we had thrombolysis treatment available free of cost, and they had arrived within the 4.5-hour treatment window, we were able to treat this patient.” 

She pauses to share that she has goosebumps. “That moment is still very vivid in my mind. It was transformative for that patient, and transformative for me. It’s what cemented my belief in how crucial treatment is and how rapidly the field of stroke is evolving,” she says. “This is why I am here and doing what I am doing now. The goal is creating systems where every patient has timely access to life-saving treatments, such as thrombolysis and thrombectomy, regardless of geography or resources.” 

Dr. Singh’s gearing up to beat health inequity on a bigger scale.

Dr. Singh’s speciality is carotid artery disease — the large artery in the neck that supplies blood flow to the brain — how it can lead to a stroke and finding ways to prevent it.  

But there’s more to be done. About 30% of patients with ischemic strokes, caused by a blockage or clot in a blood vessel in your brain, are currently labeled as “unknown cause”. According to treatment guidelines that are more than 30 years old, medical treatment happens if the artery is 50% blocked. More than 70% blocked is when surgery becomes an option. The problem is that this approach leaves risks unchecked for those with less than 50% blockages. Many have had strokes waiting to reach that threshold.  

Now, modern imaging technology like CT scans and MRI sequences are more sophisticated. There are more characteristics and features to watch out for that the imaging can detect. For example: a patient with less than 50% narrowing of the artery could have additional characteristics that signal high risk for a stroke – perhaps the artery has an ulceration or irregularities. These could signal that the person is still at a high risk for stroke and to be more aggressive with treatment before it’s too late.  

Determined to understand current approaches to identify causes of stroke and tailored treatment to inform innovative solutions, Dr. Singh is armed with a mixed-method study approach with global reach: 

• Physician survey. “I’m trying to quantify how each physician treats patients based on their imaging and/or clinical features.” 
• Physician interviews. “To see how to understand the qualitative aspect and get into as much granularity as possible. We really need to work very hard to build those bridges and gaps.” 
• Patient and caregiver focus groups. “I really want to know what’s important and meaningful to the patient. As physicians or healthcare providers, we often forget it’s really all about them. We’re trying to find innovative ways to communicate in plain language, make them understand what's going on without affecting their confidentiality, consent or autonomy.” Exploring how many people in the general population are living with carotid disease, how many of those cases have resulted in strokes, how many are likely to have repeat events, how their experience with treatment could be better, and assess their willingness to have surgery.”

Dr. Singh has already started with people in Manitoba and Alberta and is aiming for national and global reach. Using these findings, she’s working toward a clinical trial, incorporating physician and patient feedback and preferences. “My vision is that no patient would be left with a diagnosis of stroke because of an unknown cause.”

In addition to the work she does, Dr. Singh is also passionate about mentorship. It was the day she came to Canada that changed her life. Beginning a fellowship, surrounded by others in the field, inspired her to pursue a master's at Harvard. “It was a pivotal stepping stone, more than I couldn’t have imagined. I do hope to be able to mentor the next generation of stroke researchers and to drive impactful, innovative research.” 

In terms of breakthroughs, Dr. Singh believes it’s not just a single, earth-shattering moment that matters, but the series of incremental advancements through grit and perseverance, that will transform how we prevent and treat stroke. Without funding, none of that would be possible. 

Funding is more than just money; it’s a vote of confidence. “It’s a reminder that our efforts matter, and people believe in the vision of improving stroke care and outcomes.” This support allows Dr. Singh to ask bold questions, take innovative approaches and push the boundaries of treatment. “I can't even imagine a world without having funding to do what I'm doing.” 

Funding has also provided the resources she needs to build collaborative networks and mentor the next generation of researchers, ensuring that the field continues to grow and evolve. “If it were all up to me, advancing stroke care would mean achieving equitable access to care in Canada and globally. This would ultimately lead to improving outcomes in saving lives.”

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