Meet Andrew Carlson, Professor of Neurosurgery
Andrew Carlson, MD, is a Professor of Neurosurgery in the UVA School of Medicine. Dr. Carlson describes his interests and what has led him to his new position at UVA.
Brain Institute: Briefly describe your current research projects and interests.
Dr. Carlson: Spreading depolarizations (SD) are massive waves of brain inactivity that are on a scale completely different from most neuronal activity. In humans, the only way to monitor SD is with direct recordings on brain and so as a neurosurgeon, I have been involved in placing these monitoring devices and interpreting these new kinds of brain signals. Once I saw these events occurring in patients in the intensive care unit with severe brain injuries and strokes and saw patients progressively deteriorate as these events were occurring, it caused me to completely rethink how we approach these patients. Many of the neurologic phenomena that we can’t explain, from secondary stroke expansion and swelling to transient deficits without seizure to other types of neurologic deterioration, may be related to SD. My work focuses on methods to better identify when these events occur, what triggers them, and how we should manage them.
How does your research connect with the field of neuroscience?
SD is one of the most direct examples of translational neuroscience and the iterative process of discovery. As a fundamental mechanism of neuronal behavior, observations seen in preclinical models have translated remarkably well to humans. This is a paradigm shift in translational neuroscience, where molecular targets and pathways proposed to be neuroprotective have repeatedly failed to translate to human benefits. SD as a mechanism in brain injury has been remarkably translatable. This is particularly exciting given that preclinical models have predicted that SD may play a pivotal role in a variety of conditions from brain tumors to epilepsy to dementias and it is now up to us as clinicians to determine to what extent SD may be a novel therapeutic target across these many conditions.
Why did you decide to come to UVA?
Having recently received NIH funding to conduct a large scale study on the role of SD in patients with large stroke, I needed an environment with a strong research infrastructure coupled with collaborative colleagues across multiple fields from neurology, interventional radiology, neurocritical care and of course neurosurgery to successfully conduct this study. The infrastructure we are building focused on brain monitoring will serve as a foundation for multiple future studies in various conditions where SD may be relevant.
What's the best part about your job?
I treat patients with some of the most severe types of brain problems, from strokes to hemorrhages to trauma. When we can use approaches to target interventions and therapies based on that patient’s individual neurophysiology and help them come out the other side clinically doing well, it is the most satisfying reward.
What led you to a career in science and neuroscience?
While I have always been interested in discovery and innovation, the moment that changed for me was doing an experiment on a mouse while I was a resident. I was monitoring blood flow on the surface of the brain during a procedure and found that with a relatively small amount of pressure on the brain, I triggered a massive wave of decreased blood flow and vasoconstriction that spread across the entire surface of the brain. As a neurosurgery resident who was used to operating on brains and removing tumors and bleeding, I suddenly had a completely different perspective on what we could be doing. Since then, I think about how these massive but hidden events that dwarf seizures in magnitude may be involved in many of our patients and how that might affect our treatments.
What advice do you have for trainees?
Meet with a lot of potential mentors, find a project that interest you, and learn everything there is to know about whatever small slice of science you are involved in. It will strengthen your ability to digest data and you will approach that project with new insights.
What’s something new that you’ve learned recently (at work or outside of work)?
After years of thinking about it, I recently learned that SD can be detected using brain ultrasound. This could be an exciting step towards our ability to detect SD in patients without needing a surgically implanted electrode.
Where are you from originally?
I was born and raised in Los Alamos, New Mexico. My father was a tritium physicist, and my mother was an artist. I think that those two extremes of science and humanities formed me into a clinician interested in both the art and science of medicine.
What’s your favorite way to spend a day off?
I enjoy spending time with my family, driving my tractor, and playing punk rock with my bagpipe punk band.
What is a surefire way to make you laugh?
Listening to a Bo Burnham song.