We are happy to report that Monmouth’s stoke program was well represented at the 2014 New Jersey Stroke Conference earlier this month.
Two department of medicine residents, Drs Amor and Chan, presented our TIA center data in the poster session:
Dr Holland gave a talk on the role of telemedicine in stroke rehabilitation.
Coma can be caused by diffuse injury or dysfunction of the brain’s cerebral cortex or a by a lesion affecting the reticular activating system in the brain stem. A comatose patient is unable to consciously feel, speak, hear, or move.
Brain death is a very severe form of coma with complete loss of brain function. Once this has occurred, the affected patient is legally dead even though the heart, circulation and lungs may still be supported by artificial means. Patients classified as brain-dead can have their organs surgically removed for organ donation.
A patient with locked in syndrome can appear like they are comatose because they can’t move or speak, but they are aware and alert. However, they can usually blink or move their eyes, and may be able to establish communication with others in this way.
There are numerous reported cases of patients with locked in syndrome after strokes or head trauma being misdiagnosed as comatose or even brain dead, some narrowly avoiding having their organs harvested.
If you ever suspect a comatose patient may actually be locked in, you can try to establish communication with eye blinks, or get an EEG which (unlike coma) will be normal and reactive in locked in syndrome.
Patients with locked in syndrome can regain some quality of life:
This plight was made famous in the movie “The Diving Bell And The Butterfly” which was based on a memoir written by journalist Jean-Dominique Bauby.
We are trying to do a better job educating our patients about the warning signs of stroke, and that if they think they might be having a stroke they should act FAST and call 911 to get to the ER as soon as possible.
However, despite these efforts only 5% of US stroke patients get to the ER in time to receive clot busting therapy to treat their stroke. Furthermore, the quicker the drug is given, the better the outcome, TIME IS BRAIN!
We would like to see patients getting treated within one hour of the onset of their stroke, but because of the time it takes to get to the hospital and get evaluated in the ER this is rarely possible.
A pilot study in Texas is looking at getting stroke therapy administered faster by bringing the ER to the stroke patient.
The project brings a mobile CT scanner and a stroke neurologist (via telemedicine) to the patient in a specially equipped ambulance. The investigators hope to see stroke patients getting treated faster and improved outcomes.
New research has shown that shingles is a risk factor for TIA and stroke.
This increased risk is independent of other stroke risk factors such as hypternsions, smoking and high cholesterol.
People under 40 years of age who had had shingles were 74% more likely to have a stroke than those who had not.
Shingles is caused by the varicella-zoster virus (chicknepox). The infection lies dormant in nerve roots, but when reactivated leads to a painful skin rash followed in some cases devastating post herpetic neuralgia
Current recommendations from the US Centers for Disease Control and Prevention (CDC) are that anyone aged 60 years and older receives the herpes zoster vaccine.
The role for vaccination in younger individuals with vascular risk factors, and whether this can reduce stroke risk, has yet to be determined.
How could shingles cause stoke? For cases where the rash involves the head and neck have led to virus spread into the cerebral arteries via the trigeminal nerve, leading to arthritis and stroke. For other cases, the mechanism is unknown.
Click here to find out more about this study.
Take a tour of a new eLearning format we’re working on, and learn the basics of neurologic localization:
Posted by Sanya Naware MSIV, Drexel University College of Medicine
What would it feel like to only perceive one half of the world around you?
For patients with hemispatial neglect, this is an everyday reality. Hemispatial neglect or hemineglect is a condition in which damage to one hemisphere of the brain causes a lack of awareness of one contralateral side of space. It is most often a lesion of the right posterior parietal cortex affecting the contralateral side of the body. The person is unable to recognize stimuli or process them on the affected side. Left neglect is more common than right neglect because the right hemisphere is able to compensate for the loss of left hemispheric function.
Because these patients only perceive one side, they only draw what we know to be half of an image as seen in the video and image below:
Lisa Genova, a neuroscientist, expertly describes the daily challenges of living with neglect in her book Left Neglected. It is a difficult condition to imagine and this book does a wonderful job of explaining the realities and frustrations of the patient and her family.
The main character, Sarah Nickerson, suffers a traumatic brain injury in a car crash. When she wakes up, everyone around her realizes that she ignores the left side of everything. Whether it is a clock, a painting, or a room around her, she is not able to recognize the left side of anything. While she is able to feel the left side of her body, she has to focus on the fact that she has a left side in order to control her left leg and walk. In fact, when she first sees her left arm, she states that it feels like it belongs to another person, a problem called somatoparaphrenia. While eating, she only eats the food on the right side of her tray. She frequently bumps into objects on the left side of her body because she is unaware of their presence.
Sarah’s story is optimistic as her therapist and family use certain tricks to help her adjust. Some of these methods include placing bright orange tape on the left side of things around their home, using a ruler to guide her to the left side of the page, and wearing shiny jewelry on her left hand to attract attention to it.
Genova ends her book by endorsing the New England Handicapped Sports Association (NEHSA), an organization of volunteers who help people like Sarah find some independence and confidence.
Click here to find out more about right hemispheric brain damage from NEHSA.
Course presented at the 2013 ACRM Meeting
1. Introduction (Backus)
2. Surgical techniques (Elkwood)
3. EMG Evaluation for PNS and CNS Repairs (Holland)
Watch the slides as a video presentation: