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Stroke expertise started in fish tank

Neurologist's study of brain began with goldfish

By Peggy Peck
MedPage Today Managing Editor

Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical profile from MedPage Today appears each Tuesday.

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Dr. Larry Goldstein gives a lecture at the Duke Stroke Center.

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DURHAM, North Carolina (MedPage Today) -- When Larry Goldstein was in high school, his biology class project was to study the brains of goldfish -- their memory and how they learn.

Goldstein is still studying the brain more than 30 years later.

Today, it's the human brain in his role as director the Duke Center for Cerebrovascular Disease in Durham, North Carolina, and the Duke Stroke Center.

But in high school in Wantagh, New York, a prosaic suburban community, Goldstein first needed a lab for his experiments.

"There was this old storeroom in the back of the classroom that was really dirty and disgusting, but I turned it into a lab," he recalled.

Once the tanks were up and running and the goldfish were swimming to and fro, he set the rig up so that there was light only on one side on the tanks.

"I wanted to train the fish to swim toward the light," he said. "So if they swam to other side they received a 'minor' shock. The fish learned pretty quickly to swim to the light."

But he didn't stop there.

In a foreshadowing of his future as a neurologist recognized worldwide as a stroke expert, Goldstein took his goldfish experiment one step further. He injected the fish with an anticholinergic drug obtained from New York University to determine whether the drug would affect the fish's ability to learn and remember.

He was conducting these high school experiments in the 1970s. Today, brain researchers agree that anticholinergic drugs can impair cognitive function. Common anticholinergic drugs are Detrol (tolterodine) and Ditropan (oxybutinin), which are used to treat overactive bladder.

Goal in mind

Recalling his high school science project, Goldstein, 50, said he was sure even then that he wanted to pursue a career in medicine and that his goal would be study of the brain.

He attended Brandeis University as biology major and while there had the opportunity to work with Herman T. Epstein, Ph.D, a physicist who first reported that the brain grows in spurts and in humans those growth spurts correspond very nicely with the stages of cognitive development described by French psychologist Jean Piaget.

Goldstein said the opportunity to work with Epstein, which followed his memory experiments in high school biology, convinced him that it is important to "bring in interested young people while they are still high school or college students to introduce them to brain research."

As chairman of the American Heart Association's Stroke Council, Goldstein said he has been promoting a program with magnet high schools. The council brought more than 200 high school students to the American Stroke Association's International Stroke Conference near Orlando this year to expose them to cutting-edge brain research.

Learning from a legend

From Brandeis, Goldstein when to medical school at Mount Sinai in New York, and again was fortunate because Morris Bender was then conducting his Saturday clinical phenomenology labs.

Bender was an icon in neurology during the 1970s and his phenomenology labs were an opportunity for physicians from the greater New York area to bring unusual cases to him and seek his advice on diagnosis and treatment.

"Sitting in on those sessions was a great opportunity for any neurologist," Goldstein said.

He stayed at Mount Sinai for his residency training, and while he was serving as chief resident in neurology, he married his wife, Ricki, who was then chief resident in pediatrics at Mount Sinai.

Moving south

Together they headed to Duke to pursue additional training -- he in stroke prevention and treatment and she in neonatology, which is the care of newborn babies.

The Duke Center for Cerebrovascular Disease was established in 1966 and was already considered one of the world's leading stroke centers when Goldstein arrived.

But in the years since, especially since he was appointed director, he has focused on "taking what we know works in the lab and translating it into clinical treatment." At the same time he has spearheaded a renewed interest in stroke prevention.

His stroke expertise makes him a popular authority who is called upon to explain stroke or comment on prognosis when stroke makes headlines, as in the recent case of Israeli Prime Minister Ariel Sharon, who suffered a hemorrhagic stroke.

Driving with the top down

The demands on his time: teaching, research, clinical care, chairing the AHA Stroke Council, and serving as a spokesman for the American Stroke Association, leave him almost no time for leisure activities other than the occasional family dinner with his wife and two children, Sarah, now a pre-med study at the University of Virginia, and Daniel.

But he does make time for one activity that he pursues with his son: the care and maintenance of a BMW Z3 roadster that he bought in 2001. "There is nothing like washing your Z to focus your mind," he said. "My son and I have a good time going to Z rallies."

This hobby is one reason that he is likely to remain at Duke for the foreseeable future. After moving from the cold winters of New York to the gentler seasons in North Carolina, "I decided that I would always live some place where I can drive with the top down 10 months of the year. And I'm doing just that."

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