Monmouth Neuroscience at the 2014 NJ Stroke Conference

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.


Data from our TIA Rapid Evaluation Center (TREC) at the 2014 International Stroke Convention


Click here to see the abstract.

Click here and here to find out more about this innovative program.

MMC’s Stroke Program Recertified & Don’t Forget Our Stroke Support Group.


Monmouth and HealthSouth’s Stroke Survivors Support Group

Where: The Cafeteria at The Rehabilitation Hospital of Tinton Falls

When: First and Third Wednesdays Each Month

Meetings are led by Stroke Survivor Dr Zaback.

Contact Shirley at 732-460-6742 for more details.

Atrial Fibrillation? Better ask your doctor about anticoagulation.


Atrial fibrillation (AF) is a major risk factor for TIA and Stroke.

It is estimated that AF accounts for >20% of all strokes.

This risk can be lowered by as much as 60% by taking an anticoagulant such as warfarin (Coumadin).

Current guidelines recommend anticoagulation for all patients with AF, even paroxysmal (intermittent) AF:

1. If they have had a prior TIA or stroke, or

2. If they have two or more of the following risk factors: (1) age > 75 years, (2) history of hypertension, (3) diabetes mellitus, and (4) moderately or severely impaired left ventricular systolic function and/or heart failure.

If you have AF, click here to calculate your CHADS2 score and stroke risk, and click here to calculate your risk of bleeding from anticoagulation.

Your risk of stroke is much higher than your bleeding risk, right?

Many AF patients don’t get anticoagulants because they are considered a fall risk. If you had AF and need anticoagulation, you would have to fall more than 300 times a year for the harm from the falls to outweigh the benefits of anticoagulation.

Despite these guidelines, recent studies have shown that:

1. Less than half of AF patients with a high stroke risk receive anticoagulants.

2. Even less patients with paroxysmal (intermittent) AF than those with permanent AF receive anticoagulants (31 vs 49%), even though the stroke risk is the same in both groups.

3. Too few patients with new onset AF are started on anticoagulants (only 52%).

We need to do better.

Click here to download a booklet about AF and stroke.

Click here to download a worksheet that you and your doctor can use to decide if anticoagulation is right for you.

What’s best for stroke prevention, aspirin, clopidogrel or both?

We have already blogged about the benefits of anti-platelet agents in stroke prevention.

We haven’t talked about how they work, or which one(s) are best.

Platelets are an important component of blood clotting (or hemostasis) – the normal process that stops us bleeding and facilitates healing after a cut or other injury:

This same platelet led coagulation cascade can lead to blood clot formation inside intact but diseased arteries laden with atheroma – the result of years of hypertension, high cholesterol and smoking:

These small blood clots then break off and travel down the artery causing (in the case of a cerebral blood vessel) a TIA or stroke.

There are three currently available  anti-platelet medications  – aspirin, modified release dipyridamole with aspirin (Aggrenox) and clopidogrel (Plavix) which inhibit platelet activation and aggregation.


Comparative studies have shown that all three drugs reduce the risk of ischemic stroke in high risk patients who have had a previous stroke or TIA.  Aspirin is the cheapest of the three.  Aggrenox is more effective than aspirin alone, but can cause troubling headache in some patients.  Clopidogrel can be used in patients who are allergic or immune to aspirin.

Because these drugs work in different ways, investigators have asked whether combining them might be even more beneficial.

The initial studies said No.  The MATCH (2004), CHARISMA (2006) and SPS3 (2012) trials all showed that long term use of the combination of aspirin and clopidogrel failed to reduce the risk of major vascular events and also led to significant increased life-threatening bleeding complications (mainly intracranial and gastrointestinal) compared with either drug alone.


However, new data from the CHANCE study presented at this year’s international stroke meeting shows that a short course of combined treatment might be helpful:

The study enrolled 5170 patients who had suffered a TIA or minor stroke within the previous 24hrs, randomly assigned to one of two treatment groups:  The first group received aspirin (75-300 mg one-day loading dose followed by 75 mg/day).  The second group received the same aspirin regimen plus clopidogrel (loading dose of 300 mg followed by 75 mg/day) for 21 days, then just the clopidogrel alone after that.

The study showed that the 90d stroke incidence was lower in those who received both aspirin and clopidogrel.

The risk of hemorrhagic stroke and other severe bleeding was the same in the two groups.

In other words, short term combination anti-platelet therapy might be more effective in preventing stroke in this high risk TIA and minor stroke group, and this is something we will be offering patients seen in Monmouth’s innovative TIA Rapid Evaluation Center.

Dr Holland and Monmouth Neuroscience Institute’s TIA Rapid Evaluation Center Honored at the 2013 Heart Ball

The American Heart Association and American Stroke Association gathered to recognize Dr. Neil Holland and Dr. June Duck as this year’s medical honorees at the annual Heart Ball on June 21 at the Ocean Place Resort and Spa in Long Branch.


Drs Holland and Duck with their awards.

Dr. Holland was recognized for excellence in stroke care. Commended for his role in developing a TIA and Minor Stroke Rapid Evaluation Center, Dr. Holland has focused care to optimize stroke prevention without the need for hospitalization in high-risk patients.



The Monmouth TIA Center Team – L to R – Neuroscience ARNP Florence Armour, Hospital VP Shirley Hwang, Program Director Dr Holland, Neuroscience Coordinator Felesia Swanson & Dept of Medicine Chairman Dr Allan Tunkel


Dr Holland with his partners – L to R – Drs Gennaro, Anayiotos, Gilson, Holland, Herman, Davis, Mendelson & Ponce.
The success of the TIA Center is the result of close cooperation between hospital administration, all of the doctors in the practice, the Emergency Room, and many many other members of the hospitals medical and technical staff.

Find out about Monmouth’s Stroke Service and TIA Center.

Neuroscience Research A Big Hit At 2013 Resident Research Day!



PGY III resident Dr Mohamed Sheta won overall best prize, as well as the medicine and cardiology prizes, for his research project analyzing the 6-month outcome data from Monmouth’s innovative new TIA Rapid Evaluation Center.

Unfortunately, Dr Sheta was not able present his outstanding data in person, but here are pictures of him presenting some of the same data at the 2013 International Stroke Meeting in Hawaii earlier this year (left) and also at the 2013 Drexel University Research Day (right):

sheta posters

Congratulations Dr Sheta!


PGY I-III residents Drs Martin Miguel Amor, Paavani Atluri, Alan Hamza (left and right), Michael Chan (right only) and Mohamed Sheta (above) won the best poster award.

One of their findings was that most acute stroke patients not given thrombolytic therapy because of too “mild” a neurologic deficit still needed in-patient rehabilitation, so we should probably lower our threshold for administering the drug.

poster chan

Stroke Poster Revised

Congratulations to them!!


We also had a neuroscience poster by PGY II residents Drs Nagakrishnal Nachimuthu and Michael Chan on an acute stroke case we have already featured on this blog:

Neuro case report final

We’re very proud to see our medicine residents so engaged in neuroscience research.

Keep up the good work!