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A/Prof Thanh Phan

A/Prof Thanh PhanA/Prof Phan has been Head of Stroke at Monash Medical Centre since 2004 and has developed a first class stroke team, providing stroke services in the areas of Transient Ischemic Attack, acute thrombolysis, interventional radiology and stroke unit care.

A/Prof Phan obtained his MBBS from University of New South Wales and has subsequently undertaken fellowships in Epilepsy, Neurology, Stroke and Neurocritical care in Cerebrovascular disease, including time at the Mayo Clinic, Rochester. He is a Fellow of the Royal Australian College of Physicians and was an NHMRC Postgraduate Research Scholar. In 2008 he completed his PhD (University of Melbourne) with a thesis entitled “Applications of MR Imaging in acute ischaemic stroke”.

Currently a Consultant Neurologist for Southern Health, A/Prof Phan undertakes ward service at both Clayton and Dandenong campuses, consults at Monash Neurology and in addition runs comprehensive stroke and TIA outpatient clinics. He is actively involved in the teaching of Advanced Physician Trainees in both Neurology and Stroke and provides supervision for a Doctorate student and the Monash Stroke Fellowship programme. In 2008 he was appointed a Clinical Associate Professor in the Department of Medicine, Southern Clinical School, Monash University.

Research Role
A/Prof Phan has been involved in clinical research for a number of years, including design, statistical analysis and writing up of a number of studies and is widely published in the area of stroke and imaging. His research interest is primarily in vascular anatomy, neuro-anatomy and prediction of stroke outcome.

Vascular anatomy

  • Probabilistic mapping of infarct topographies
  • Redefining the ‘watershed’ stroke concept
  • Role of collaterals in penumbra rescue
  • Defining the vulnerable carotid artery

Neuro-anatomy

  • Prediction of stroke outcome from topography
  • Neuroanatomical substrates of aphasia and neglect
  • Motor system physiology

He is continuing research in the areas of his PhD training including ischaemic penumbra, development of surrogate markers for clinical trials in stroke, mapping of cerebral vascular anatomy and prediction of stroke outcome using CT and MRI imaging methods. He is also involved in studies of imaging of carotid arteries and cerebral aneurysms.

He collaborates with researchers on topics related to Ageing, currently including the Tasmanian Study of Cognition and Gait (TASCOG), and the Cognition and Type 2 Diabetes in Older Tasmanians (CDOT) study.

Current Projects

Stroke risk factors
-carotid artery geometry in the risk of atherosclerosis
-imaging of aortic arch atheroma

TIA model of care
-Monash TIA Triaging and Treatment (M3T) system, an alternative model of TIA care

Acute stroke studies
-cerebral collateral circulation in acute stroke
-mapping of neurological deficit in acute phase of stroke eg aphasia
-prediction of outcome following intracerebral haemorrhage

Post-acute stroke studies
-Post-stroke mood disorders
-mapping of neurological deficit in chronic phase of stroke eg aphasia
-mapping of vascular anatomy
-warfarin cessation in patients with atrial fibrillation

Gait disorders
-neuroimaging of gait disorders

Coma
-prediction of outcome following coma

Clinical Role
As Head of stroke, he has been responsible for establishing the unique Monash TIA Triaging and Treatment (M3T) system, an alternative model of care suitable to the large population served by Monash Medical Centre with similar efficacy as more expensive international models. This model is based on TIA clinics that alleviate the need for hospital admission and lessen the demand on the Emergency Department and limited hospital resources. His extensive experience in acute thrombolysis, acute stroke management and secondary intervention has been crucial to the successful treatment of numerous patients and established Monash Medical Centre as a leader in stroke care. He has also recently established a new stroke unit at Dandenong Hospital.

In order to standardise stroke management, A/Prof Phan has established protocols to co-ordinate care between Emergency Departments, Radiology, Neurosurgery, Cardiology, Haematology and Stroke. The use of the protocols has led to reduced length of stay and efficiency in the use of investigations. He was integral in setting up the Rapid Admission pathway in Emergency Department to rapidly admit neurology and stroke patients, allowing the Emergency Department to meet their Key Performance Indicators.

Awards
- Australian Association of Neurologists Overseas Training position in Neurology, Mayo Clinic 1998
- NHMRC scholarship (medical and dental) 2000-2003
- Australian Association of Neurologists/Novartis Travelling Fellowship 2001

Invited Talks
A/Prof Phan has been invited to give lectures on clinical aspects of Stroke by the Royal Australiasian College of Physician under the “Rural Professorship” scheme and at grand rounds of other Melbourne hospitals.

Publications
A/Prof Phan has published more than 40 articles in international journals and book chapters on diverse topics in neurology, aging brain and imaging. He has published several book chapters in Neurology, Radiology and Geriatric Medicine textbooks, and has provided manuscript reviews for prestigious international journals such as “Stroke”, “Neurology”, “Neuroimage”, “Drug and Aging”, “Journal of Neurocritical Care”, “Journal of Clinical Neurosciences” and “International journal of Stroke”

Major publications

  1. Phan, T. G., Fong, A. C., Donnan, G. A., Srikanth, V. Reutens, D. C. Digital map of border region of the middle and posterior cerebral artery, Cerebrovascular Dis 2009 (Accepted November 2008) (IF 2.6)
  2. Phan, T. G., Wright, P, A. C., Donnan, G. A., Reutens, D. C. Digital map of middle cerebral artery infarcts associated with trunk and branch occlusion, Stroke, 2005; 36: 986-991. (IF 6.3, citation 16)
  3. Phan T G, Huston J, Brown RD, Wiebers DO. Enlargement of Intracranial Saccular Aneurysms as Determined by Serial MR Angiography. J Neurosurg 2002; 97: 1023-1028 This article draws attention to a non-invasive method to monitor patient with intracranial aneurysm who did not receive surgery. This was discussed in an Editorial in Journal of Neurosurgy ( 2002: 97:1011-1012) and correspondence to the same journal (2002: 97:1012-1013)
  4. Phan TG, Huston J,Bernstein MA, Riederer SJ, Brown RD. Contrast-enhanced MRA of the Cervical Vessels: Experience With 422 Patients. Stroke 2001; 32: 2282-2286
  5. Phan TG, Koh M, Wijdicks EFM. Safety of discontinuation of anticoagulation in patients with intracranial hemorrhage at high thromboembolic risk. Arch Neurol 2000; 57: 1710-1713.

Other Publications

  1. Srinivasan J. Miller S. Phan TG, Mackay M. Delayed Recognition of Initial Stroke in Children: The Need for Increased Awareness. Pediatrics manuscript number 2008-3544.R2. Accepted 13 March 2009
  2. Srikanth, V., Beare, R. J., Blizzard, L., Phan, T. G., Stapleton, J. M., Chen, J., Callisaya, M., Martin, K., Reutens, D. C., Cerebral white matter lesions, gait, and the risk of incident falls: a prospective population-based study, Stroke 2009; 40: 175-180. (IF 6.3, citation 0)
  3. Phan, T. G., Donnan, G. A., Masatoshi, K., Mitchell, L. A., Molan, M., Fitt, G., Chong, W., Holt, M., Reutens, D. C. Assessment of suitability of thrombolysis in middle cerebral artery infarction: A proof of concept study of a stereologically-based technique, Cerebrovascular Diseases 2007; 24: 321-327. (IF 2.6, citation 0)
  4. Phan, T. G., Fong, A. C., Donnan, G. A., Reutens, D. C. Digital map of posterior cerebral artery infarcts associated with posterior cerebral artery trunk and branch occlusion, Stroke, 2007; 38: 1805-1811. (IF 6.3, citation 1)
  5. Arakawa, S., Wright, P. M., Koga, M., Phan, T. G., Reutens, D., Lim, I., Gunawan, M. R., Ma, H., Perera, N., Ly, J., Zavala, J., Fitt, G., Donnan, G. A., Ischemic thresholds for gray and white matter: a diffusion and perfusion magnetic resonance study, Stroke 2006; 37: 1211-1216 (IF 6.3, citation 13)
  6. MR Stroke Collaborative Group: Phan TG, Donnan GA, Davis S, Byrnes G. Proof-of-principle phase II MRI studies in stroke: sample size estimates from dichotomous and continuous data, Stroke 2006; 37: 2521-2525 (IF 6.3, citation 13)
  7. Phan, T. G., Donnan, G. A., Koga, M., Mitchell, L. A., Molan, M., Fitt, G., Holt, M., Reutens, D. The ASPECTS template is weighted in favor of the striatocapsular region, NeuroImage 2006; 31: 477-481. (IF 5.5, citation 4)
  8. Phan TG, Srikanth V, Reutens DC.Therapeutic Implications for Routine Transthoracic Echocardiography in Acute Ischemic Stroke Patients (letter) Stroke, 2006; 37: 11 – 12 (IF 6.3, citation 0)
  9. Phan TG, Srikanth V, Reutens DC. Borderzone Infarction: Stroke Topography Does Not Easily Equate With Stroke Mechanism. Stroke 2006; 37:2658 (IF 6.3, citation 0)
  10. Ho, P. W., Reutens, D., Phan, T. G., Wright, P. M., Markus, R., Indra, I., Young, D., Donnan, G. A., 2005, Is white matter involved in patients entered into typical trials of neuroprotection?, Stroke 2005; 36: 2742-2744 (IF 6.3, citation 1)
  11. Koga, M., Reutens, D. C., Wright, P. M., Phan, T. G., Markus, R., Pedreira, B., Fitt, G., Lim, I., Donnan, G. A., 2005, The existence and evolution of diffusion-perfusion mismatched tissue in white and gray matter after acute stroke, Stroke, 2005; 36: 2132-2137. (IF 6.3, citation 9)
  12. Phan TG, Huston J, Campeau NG, Brown RD, Fulgham JR, Wijdicks EFM. Early evolution of deficits in acute ischemic stroke: Mean transit time, relative blood volume, and relative blood flow. J Stroke Cerebrovascular Dis. 2002; 11: 66-71
  13. Phan TG, Wright PM, Markus R, Howells DW, Davis SM, Donnan GA. Salvaging the ischaemic penumbra: more than just reperfusion? Clin Exp Physiol Pharm 2002; 29: 1-10
  14. Henderson RD, Phan TG, Piepgras DG, Wijdicks EFM. Mechanisms of cerebral hemorrhage after carotid endarterectomy. J Neurosurg. 2001; 95: 964-969.
  15. Rogers E, Phan TG, Wijdicks EFM. Myocardial infarction from lateral medullary hemorrhage. Neurology 2001; 56: 567-568
  16. Phan TG, Fulgham J, Cascino G. Ictal abdominal pain heralding parietal lobe hemorrhage. Seizure 2001;10: 56-59.
  17. Tang-Wai D, Phan TG, Wijdicks EFM. Hypertensive encephalopathy presenting with thunderclap headache. Headache 2001; 41: 198-200.
  18. Phan TG, Wijdicks EF.Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves. J Neurol Neurosurg Psychiatry. 2001; 70: 820-1.
  19. Worrell GA, Wijdicks EFM, Phan TG, Damario MA, Sinak LJ.2. Ovarian hyperstimulation syndrome with massive stroke due to intracardiac thrombus. Neurology 2001; 57: 1342.
  20. Phan TG, Wijdicks EFM, Fulgham J, Worrell G. Pseudo-subarachnoid hemorrhage on CT in anoxic encephalopathy. J Neuroimaging 2000; 10: 236-237
  21. Phan TG, Krauss WR, Fealey RD. Recurrent lumbar ependymoma presenting as 'Communicating hydrocephalus'. Mayo Clinic Proceedings 2000; 75: 850-852
  22. Phan TG, Wijdicks EF. Diffusion-weighted magnetic resonance imaging in brain death.Stroke. 2000;31: 1458-9.
  23. Phan TG, Koh M, Vierkant RA, Wijdicks EFM. Hydrocephalus is a determinant of early mortality in putaminal hemorrhage. Stroke 2000: 31: 2157-2162
  24. Phan TG, O'Neill BP, Kurtin P. Post-Transplant Central Nervous System Lymphoma (PT-PCNSL). A Clinical and Imaging Study. Neuro-oncology 2000: 2; 235-244
  25. Koh M, Phan TG, Atkinson JLD, Wijdicks EFM. The role of neuroimaging in the management of cerebellar infarct with mass effect. Stroke 2000: 31; 2062-2067
  26. Phan TG, Evans B, Huston J. Pseudo-ulnar palsy from small infarct of the precentral knob. Neurology 2000; 54: 2185
  27. Friend KL, Crimmins D, Phan TG, Sue CS, Colley A, Fung VSC, Morris JGL, Sutherland GR, Richards RI. Detection of a novel missense mutation and second recurrent mutation in the CACNA1A gene in individuals with EA-2 and FHM. Human Genetics 1999; 105: 261-265
  28. Phan TG, Wijdicks EFM. A sensory level on the trunk from vertebral artery dissection. How much more subtle can we get. J Neurol Neurosurg Psychiatry 1999; 66: 691-692
  29. Phan TG, Chen S, Somerville ER. Adult onset seizure as the presenting feature of neurosyphilis. Epilepsia 1999; 40: 1309-1311
  30. Phan TG, Wijdicks EFM. Sudden neurological deterioration from silent meningioma following breast cancer surgery. Anaesthesia 1999; 54: 1123-1125
  31. Phan TG, Bleasel AF. Transient loss of consciousness: diagnosis and investigation. Modern Medicine. 1998; November: 38-47
  32. Phan TG, Wijdicks EFM. Intra-arterial thrombolysis in vertebrobasilar circulation ischemia. Critical Care Clinics 1999; 15: 719-741
  33. Koh M, Phan TG, Wijdicks EFM. The surgical management of cerebellar infarct with mass effect. The Neurologist May 2000
  34. Phan TG, Wright PM, Markus R, Howells DW, Davis SM, Donnan GA. Salvaging the ischaemic penumbra: more than just reperfusion? Clin Exp Physiol Pharm 2002; 29: 1-10

    35. Book chapters:

  35. Phan TG, Wiebers DO. Chapter 41: Asymptomatic Carotid Stenosis. In Neurological Therapeutics: Principles and Practice. Volume 1. Editor John Noseworthy. Published by Martin Dunitz in 2003.
  36. Donnan GA, Wright P, Markus R, Phan TG, Reutens DC. Chapter 15: The ischemic penumbra. In Magnetic Resonance Imaging in Stroke. Edited by Stephen Davis, Marc Fisher, Steven Warach. Published by Cambridge University Press in 2003.
  37. Huston J, Flemming KD, Phan TG. Chapter 35: Imaging of aneurysms. In Diagnostic and Therapeutic Imaging of the Nervous System. Editors Richard L2-atchaw, John Kucharczyk, Michael Moseley, Beth Yarbrough. Published by Mosby in 2004
  38. Srikanth V, Phan TG. Stroke - Clinical Presentation, Management and
    Organization of Services. Brocklehurst Textbook of Geriatric Medicine,
    7th edition. Editors, Rockwood, Fillit, Woodhouse. (Invited Book
    Chapter, accepted for publication July 20, 2008).

    39. Review articles:

  39. Phan TG, Wright PM, Markus R, Howells DW, Davis SM, Donnan GA. Salvaging the ischaemic penumbra: more than just reperfusion? Clin Exp Physiol Pharm 2002; 29: 1-10

Grants

  • 2007-2010: Grant type – CI, NHMRC Project Grant (436797) for $495,000. Project – Diabetes and Cognitive Function.
  • 2007-2008: Grant type – Monash/CSIRO for $50,000. Project – Carotid Artery Geometry and risk of stroke.
  • 2006-2009: Grant type – CI, NHMRC Project Grant (491109) for $518,000. Project – TASCOG.
  • 2005-2006: Grant type - Royal Hobart Hospital Research Foundation for $17,000. Project – TASCOG.
  • 2004-2005: Grant type –Brain Foundation for $8,000. Project – TASCOG.
  
Stroke and Ageing Research