Medicine and Health Sciences Commons^™

Spontaneous Spinal Epidural Hematoma Presenting As A Stroke Alert: A Case Report, Christian Flores Do, Monisha Bindra Do, Adam Sigal Md, Michael A. Romeo Do

Tower Health Research Day

No abstract provided.

Real-World Comparison Of Standard Versus Reduced Dose Apixaban In Stroke Prevention And Bleeding Risk In Atrial Fibrillation Patients With Chronic Kidney Disease: A Retrospective Analysis Of Trinetx Data., Sameh Gomaa, Joseph Hellman, Olutoyin Lawal, Edward Hovick, Slawomir Kusmirek

Tower Health Research Day

No abstract provided.

Measuring Fibrinogen To Shorten Post-Alteplase Administration Window, Ahmad Hamid, Jennifer A. Ross, Mandy J. Binning

Tower Health Research Day

No abstract provided.

Optimization Of Baseline Values For The Bionik Inmotion Arm/Hand Rehabilitation Robot, Marysol Cabello, Diego Rojano, Daniel Salinas, Ramiro Oquita, Victoria Cuello, Kelsey Potter-Baker

Research Symposium

Background: Clinical studies utilizing the Bionik InMotion Arm/Hand robot are increasing in recent years. However, there is a lack of standardized values from healthy participants that can be used to compare to patients with stroke or other neurodegenerative disorders. We aim to create this standardized set of values by employing the new Bionik InMotion Arm/Hand robot on healthy participants. Establishing normative values will allow our lab, and other laboratories, to have a baseline that can be used to track rehabilitation progress in patients with neurological disorders, such as stroke. Creating this standardization may also allow for more tailored rehabilitative approaches …

Analysis Of Secondary Neurodegeneration In Spinal Cord Mri In Post-Stroke Patients, Sarvani Uppati, Sravani Mannuru, Kelsey Baker

Research Colloquium

Background: Stroke, also termed cerebral infarction, results in neurodegeneration and neuroinflammation in the brain at area of the infarct and peri-infarct regions. It has also been established that damage in the motor pathways including the corticospinal tract contribute to motor deficits in post-stroke patients. Recent research has recognized the involvement of alternate sensorimotor pathways in the spinal cord that underline disease progression and the degree of functional recovery post-stroke. Evaluating the role of alternate sensorimotor pathways in the brain can be challenging, since the pathways remained crossed until they reach the spinal cord. Although MRI has been used to examine …

Creutzfeldt-Jakob Disease, A Stroke Masquerade Case: Case Report, Natalia C. Pinto, Yilen Karen Ng-Wong, Reham Majzoub

Research Colloquium

Background: The first Creutzfeldt-Jakob disease (CJD) outbreak was in 1996 in the UK, where 10 cases of a new rare neurological disease were reported. CJD continues to be an unclear neurodegenerative disease. The disease is usually higher in the retina and the brain, which in the majority of cases results in neurological symptoms, including rapidly progressing dementia, extrapyramidal signs, myoclonus, and visual symptoms with a mean age of 67. There are 3 groups of human prion disease, sporadic CJD accounts for about 85% of the cases.

Case presentation: A 66-year-old woman who presented with slurred speech and forgetfulness started in …

Covid-19 As A Second Hit For Anti-Phospholipid Syndrome, Himabindu Kolli, Pooja Maknoor, Celin Rajan, Nevin Varghese

Research Colloquium

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis, usually in setting of underlying autoimmune disorders. Here, we present a case of anti-phospholipid syndrome post covid infection.

Case Presentation: 41-year-old lady presented to the ER with complaints of left sided facial droop for 3-day duration. On further evaluation, she was found to have subacute ischemic stroke and was managed with anticoagulation and supportive treatment. Past medical history is significant for a recent diagnosis of Covid infection and for subsequent development of lower extremity deep vein thrombosis (DVT). She was started on anticoagulation with rivaroxaban for …

Neurodegeneration Difference Between The Non-Lesioned And Lesioned Hemisphere In Stroke Patients, Nuvia Cortez, Elle Wynn, Kelsey Baker

Research Symposium

Background: Stroke is the 4th leading cause of death in Hispanics. It has generally been suggested that neurodegeneration is isolated to the lesioned hemisphere . However, recent evidence has suggested that the non-lesioned side of the brain may also undergo neurodegeneration. Here, we sought to evaluate the amount of neurodegeneration in the lesioned and non-lesioned hemisphere in chronic stroke patients and identify the impact of stroke size and location.

Methods:T1-weighted magnetic resonance imaging and diffusion weighted imaging (DWI) of the brain was collected in 23 patients with chronic stroke and 14 healthy controls. We quantified the amount of neurodegeneration …

Stroke Mimics: A Challenge For The Clinician, Khairiya Haj-Yahya, Rodolfo Singleterry, Dayan Ojeda Damas, Carlos Ramos, Laura Garcia, Meghan Danielle Cantu

Research Symposium

Background: Stroke is defined as an acute neurologic injury that is the result of a disruption in cerebral perfusion due to the blockage or rupture of an artery. Ischemic infarcts represent up to 87% of all strokes, and most commonly present with sudden onset, focal neurologic deficits that are consistent with a vascular etiology. Approximately 30% of patients presenting to the Emergency Department with stroke-like symptoms are unfortunately stroke mimics.

Stroke mimics such as syncope, sepsis, seizure, and migraines can present with stroke-like symptoms and are often indistinguishable from true strokes. The study conducted will serve to provide medical residents …

Comparing Stroke Symptom Recognition And Intervention Times In The Rio Grande Valley, Joshua M. Ninan, Kelsey Baker

Research Symposium

This is a retrospective study that aims to evaluate the duration from onset of stroke-like symptoms to presentation to medical facilities for aid in the Rio Grande Valley. The main goal of the study is to understand the extent of pre-hospital delays with regards to the treatment of stroke in the RGV.

Influence Of Age, Race, And Ethnicity On Pre-Hospital Stroke Time Intervals In The Rio Grande Valley., Elio E. Garcia Sosa

Research Symposium

Currently, stroke represents one of the leading causes of death in the USA. Despite recent advances in acute stroke management such as thrombolytic administration and/or endovascular intervention, many patients remain ineligible for these treatments due to delay in treatment. There has been a great emphasis by healthcare professionals on improving “door to needle” time with very encouraging results. Unfortunately, there still exists a gap in these delays, and that is the onset to hospital presentation interval. This study aims at evaluating the time interval from the onset of the symptoms to when the patient presents to the healthcare facility. The …

Case Study Of Horner Syndrome Due To Internal Carotid Artery Dissection, Kajel Patel

Rowan-Virtua Research Day

Carotid artery dissection can occur either spontaneously or because of trauma. It is usually the most common cause of stroke in middle-aged patients. The symptoms can be transient or persistent and typically occur a few days after the inciting traumatic event.

The Effectiveness And Outcomes Of Oculomotor And Visual Field Deficit Rehabilitation Secondary To Ischemic Cerebrovascular Accident: A Literature Review, Maanas Chiplunkar

Rowan-Virtua Research Day

Visual field loss and oculomotor dysfunctions are two common vision deficits caused by cerebrovascular accidents. Oftentimes these deficits can result in a loss of independence for patients and depression. Neurovisual rehabilitation is a frequently overlooked aspect of stroke rehabilitation, so investigating the current rehab approaches and the factors that play a role in the effectiveness of these methods is crucial so that clinicians can provide more direct and focused treatment for their patients. This literature review research process used PubMed, NCBI, and EbscoHost as primary databases. Preliminary results showed that restitutive and compensatory rehabilitation approaches are effective for treating visual …

Intraoperative Changes In Somatosensory Evoked Potentials As A Predictor Of Perioperative Stroke In Carotid Endarterectomy, Justin W. Meinert Bphil, Parthatharasy D. Thirumala Md, Jeffrey R. Balzer Phd, Donald J. Crammond Phd, Eyad E. Saca Md

Tower Health Research Day

No abstract provided.

Evaluating The Relationship And Outcomes Of Ischemic Stroke In Patients With Covid-19 While Also Reviewing Overall Incidence And Mortality Of Stroke In Vulnerable Populations In The Us, Jaime Dougherty

Rowan-Virtua Research Day

COVID-19 has affected the worldwide population since early 2020 and has remained a health issue. Among the various symptoms and outcomes people are encountering when infected with COVID-19, this virus has also been connected to severe vascular insults involving large vessel occlusions.

Current stroke statistics indicate a nearly twice as high risk of stroke in African Americans when compared to whites. This brings into question how social determinants of health are affecting COVID-19 and stroke incidence.

The purpose of this review is to investigate the relationship between COVID-19 and ischemic stroke while advocating for a more robust primary prevention approach …

Helicopter Ems And Its Outcomes In Stroke Patients During Transport From Rural Ed To Comprehensive Stroke Center, Asim Shafique, Jillian Baker

Rowan-Virtua Research Day

The theory that will be examined in this review pertains to creating an algorithm based upon whether patients suffering from a stroke with a large vessel occlusion should be taken to a stroke center from rural emergency departments for a mechanical thrombectomy via helicopter EMS (HEMS) or ambulance transport. Such an algorithm does not exist in healthcare, so this literature review will have the potential to be clinically applicable. This review will aim to identify the proper method of transportation during an ischemic stroke with the goal of reducing mortality rates and improving outcomes. Most rural communities are over an …

Secondary Stroke Prevention Retrospective Analysis, Mansi Panse, Samantha Plasner, Nasrine Bendjilali

Rowan-Virtua Research Day

Stroke is the leading cause of serious long-term disability among adults in the United States, and there are well recognized modifiable risk factors for stroke. Secondary prevention efforts to reduce the likelihood of recurrent stroke should be top priority in this high-risk patient population. The role of the primary care team in implementing and assisting patients with adherence to secondary prevention efforts is critical. The objective of this retrospective analysis is to examine how successful primary care providers are at implementing secondary stroke prevention guidelines.

Preventing secondary stroke is critical to the welfare of this high-risk population and ultimately saves …

Stroke In Hfref Without Atrial Fibrillation And Concurrent Protein S Deficiency: What Is The Best Treatment?, Rohan Umrani, Trinava Roy, Bhavana Kadiyala, Yvette Wang

Rowan-Virtua Research Day

Hypercoagulable disorders are often the culprit for repeated strokes in young patients, with or without other comorbidities

Medications typically used for stroke prophylaxis:

• Warfarin
• Aspirin
• Direct Oral Anticoagulants (DOACs)

Warfarin is the preferred method of anticoagulation for stroke prophylaxis in patients with hypercoagulable disorders

A deficiency of protein S increases the risk of pro coagulation due to a relative deficiency of anticoagulants.

Patients with protein S deficiency tend to have recurrent venous thromboses and pulmonary emboli

Case Report: Abdominal Aortic Aneurysm, Aishwarya Reddy, Jeffry Rima, Nick Morey, Jalisa Jones, Connor Lambert, Shiv Dhiman, S Arya

Research Day

Many research studies have demonstrated that age is a primary risk factor for the prevalence of diseases within developed countries, most notably concerning cardiovascular disease, which has been found to be the leading cause of death globally. Among the diseases that fall beneath this umbrella term of cardiovascular disease, aortic aneurysms (AA) and cerebrovascular accident (CVA; i.e. stroke) are two of the more prevalent and well-known diseases that are identified among the elderly population. However, despite the increasing prevalence of both AAs and CVAs within the elderly in tandem with their shared risk factors - hypertension, smoking, hyperlipidemia, etc. - …

Cme: Ischemic Stroke Recognition And Management, Mae Missana

Capstone Showcase

Stroke is defined as a sudden onset of neurologic deficit caused by interrupted blood flow. Stroke is divided into two subtypes: ischemic and hemorrhagic. Roughly 87% of all strokes are ischemic with infarcts caused by obstruction to carotid artery circulation or vertebrobasilar artery circulation. Symptoms of ischemic and hemorrhagic stroke are similar on physical exam;therefore use of imaging is essential to determine treatment pathway. Asstroke is one of the leading causes of death in the United States, it is important to recognize the signs and symptoms, employ the necessary tools to evaluate and identity stroke, and deliver timely treatment to …

The Benefit Of Bdnf Modification In The Treatment Of Post-Stroke Depression, Christine Gordynskiy-Ageyev

Capstone Showcase

Neuroplasticity has been a rapidly expanding area of research, and its findings have elucidated the potential of taking advantage of some of its components for the treatment of various neural pathologies. Stroke is the most common cause of long-term disability, and it is a disease process that affects many people. There are many rehabilitation programs that seek to restore a patient’s motor and cognitive functions after stroke; if not fully, then at least partially. Unfortunately, mental health changes contribute in large part to the overall disability of a patient, but these changes are not always targeted in these programs. In …

Alteplase Administration For Acute Ischemic Stroke (Ais) In Er - A 5-Year Review, Ali A. Saherwala, Md, Diana Tzeng, Md, Robin Dharia, Md

House Staff Quality Improvement and Patient Safety Conference (2020-)

• ER visits for AIS grown in last 10 years by 25%
• Ongoing effort by AHA/ASA to improve access to care with early stroke recognition and awareness
• Time is brain; rate of thrombolysis with alteplase (ALT) should increase with better EMS systems, awareness, and education

Retrograde Thromboembolism From The Proximal Descending Thoracic Aorta Leading To Recurrent Acute Cerebrovascular Events, Mark Staroelsky, Akash Patel, Gregory Holland, Nishant Parikh, Peter Bulik

Rowan-Virtua Research Day

In the United States, approximately 800,000 individuals experience a stroke every year

Nearly 25% of strokes are recurrent

Cryptogenic strokes, or those with unknown causes after testing, make up a significant portion of ischemic strokes, as many as 32%

Retrograde thromboembolic events originating from the proximal descending thoracic aorta should be considered as a potential etiology in cryptogenic strokes

The appropriate management of embolic events from aortic atheroma needs further research

Here, we present a case of a 55-year-old male who had recurrent cryptogenic strokes whose origin was discovered to stem from retrograde embolic phenomena from atheroma located within the …

Case Report: Repeated Use Of Tetrahydrocannabinol Associated With Severe Cerebral Vasoconstriction, Pooja Patel, Ryna Then, Dena Little

Rowan-Virtua Research Day

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare neurological syndrome. The classic presentation consists of recurrent, severe, ”thunderclap” headaches with neuroimaging findings consistent with segmental vasoconstriction of cerebral arteries. Sympathomimetics including cannabinoids have been found to be triggers in many cases of RCVS. Complications include subarachnoid hemorrhage, intracerebral hemorrhage, cerebral edema and ischemic infarction.

This case highlights the potential devastating and irreversible effects of RCVS precipitated by exposure to a sympathomimetic agent. The case emphasizes the importance of patient counseling regarding abstinence from agents that may provoke RCVS.

Carotid Endarterectomy Versus Carotid Stenting In The Prevention Of Stroke In Asymptomatic Carotid Artery Disease, Alison N. Stover

Capstone Showcase

Stroke is the leading cause of disability and second most common cause of death worldwide. Ischemic stroke accounts for 80% of all strokes, and are the result of the blood supply to the brain being interrupted abruptly. Atheroembolism, or a cholesterol embolism, is a major contributor to ischemic strokes. Due to this fact, treatment of carotid artery stenosis has been aimed at preventing atheroembolization by controlling plaque buildup in arteries before they have the chance to break off and cause harm. In an attempt to prevent future stroke (O) in adult patients with asymptomatic carotid artery disease (P), will performing …

Early Follow-Up Phone Calls To Reduce 30-Day Readmissions For Stroke Patients Discharged To Home, Olivia Gruder, Md, John Allred, Md, Frank Anzelmi, Md, Judy Diep, Md, Belle English, Md, Aniket Natekar, Md, Priyadarshee Patel, Md, Louis Porreca, Md, Sanskruti Patel, Md, Shaista Alam, Md, Rodney Bell, Md, Robin Dharia, Md, Elan Miller, Md, Diana Tzeng, Md, Fred Rincon, Md< Msc, Facp

House Staff Quality Improvement and Patient Safety Conference (2020-)

Patients admitted to the acute stroke unit with minor neurologic deficits are frequently discharged directly to home rather than to a rehabilitation center. Data from our tertiary care comprehensive stroke center has shown that in a 7-month period, 37% of patients admitted to the stroke unit were discharged home versus discharged to rehab or other location. Our average 30-day readmission rate for home discharges is 5.14%. More than 30% of these readmitted patients had been discharged on a Thursday or Friday on their index admission. When discharged home, patients typically are tasked with several responsibilities including but not limited to …

Maternal Morbidity Outcomes In Idiopathic Moyamoya Syndrome In New York State, Hajere J. Gatollari Mph, Amelia K. Boehme Ph.D., E. Sander Connolly M.D., Alexander M. Friedman M.D., Mitchell S.V. Elkind M.D., Joshua Z. Willey M.D., Eliza C. Miller M.D.

Rowan-Virtua Research Day

Background: Pregnancy is associated with an increased risk of stroke in young women. Idiopathic moyamoya syndrome (IMMS) is a rare condition characterized by progressive narrowing of large cerebral arteries resulting in flimsy collaterals prone to rupture or thrombosis. Data are limited on pregnancy outcomes in women with IMMS. We hypothesized that IMMS would be associated with increased pregnancy morbidity, including stroke.

Conclusion: Pregnancies within 1 year prior or any time after IMMS diagnosis did not have increased maternal morbidity compared to unexposed pregnancies after adjusting for age and clustering of women with multiple pregnancies. Prospective studies are needed to better …