74R–neurology
Harold Adams’ 50-year career in stroke research cemented his place as a titan of the field. Among his significant contributions is the National Institutes of Health (NIH) Stroke Scale, an endeavor that began in the mid-1980s.
“At the time, there were reports in animal literature that naloxone might improve stroke outcomes,” Adams says. “We did a dose escalation study and could not find evidence that it worked, but during that study, we realized we needed a way to assess patients.”
The 42-point assessment measures a patient’s ability to understand and perform a predefined list of simple tasks, allowing physicians to describe and monitor changes in condition after a stroke.
“The scale turned out to be an extremely robust predictor of outcomes,” Adams says. “So far, it still remains the standard instrument for assessing patients with acute ischemic stroke."
Adams was also the principal investigator of the landmark Trial of ORG-10172 in Acute Stroke Treatment (TOAST). The trial debunked the use of anticoagulant therapies, such as heparin, which were then in common clinical use for stroke even though there was little evidence to support it.
"You always want a study that shows something positive, right?” he says. “But a negative trial like this can be just as important because it took people away from a therapy that had been used with complications and without efficacy.”
The trial also led Adams to develop the TOAST Classification, which denotes five types of ischemic stroke according to the nature, location, and cause of brain injury.
Adams continued to serve as a national advisor on stroke through the 1990s and 2000s. As a director of the American Board of Psychiatry and Neurology, he spearheaded the development of vascular neurology as a subspecialty. He oversaw three cycles of guideline development as chair of the American Heart Association’s Stroke Council. He served on the advisory panel to the U.S. Food and Drug Administration (FDA) to recommend the approval of tPA therapy—also known as "clot-busting" drugs—which dissolve blood clots that can cause stroke.
“When I was a resident, we approached stroke with a sense of helplessness,” he says. “What that FDA approval really did was change the public’s attitude. All of a sudden, stroke became an emergency."
These advancements culminated in the University of Iowa’s Code Stroke Program. Through education and collaboration, the program brought together Iowa health care providers to set standards for emergency stroke response. Now, when a patient in Iowa is diagnosed with stroke, they are transported by air to the UI Hospitals & Clinics main campus to receive lifesaving protocols not available at smaller hospitals.
“Now we say if you’re having a stroke, get help right now, because we can do something about it,” Adams says.
Though he has been honored with such prestigious awards as the A.B. Baker Award for Lifetime Achievement in Neurological Education from the American Academy of Neurology, Adams’ greatest joy is teaching. He was awarded the Ernest O. Thielen Clinical Teaching and Service Award in 2010 and has been named Teacher of the Year 14 times. Even in retirement, he continues to teach medical learners.
“If you love what you’re doing, love your patients, love your colleagues, and love your family, you’ll have a successful career,” he says.