Although stroke is a leading killer, experts say it demands more attention and funding.

On a Thursday night in mid-January, Dr. Rahul N. Mehra, a prominent Tampa psychiatrist, wasn’t feeling well and laid down on a couch in his south Tampa home. His wife Cathy was resting in the bedroom when she heard a loud thump and came out to investigate. She found her husband on the floor, disoriented.

“She looked at me and clearly realized that something wasn’t right,’’ Dr. Mehra said. “She asked me ‘who am I?’ and I wasn’t able to respond, so she immediately called the paramedics.’’

Dr. Rahul Mehra

Dr. Mehra is the CEO and Chief Physician Executive for the National Center for Performance Health (NCPH), a Tampa based health care company. NCPH creates and provides original and innovative resources intended to empower professional and amateur athletes of all ages. NCPH clients include large and small businesses, schools, colleges, universities and non-profit agencies. Dr. Mehra created a tool kit called Emotional Vaccines to address the effect of stress for individuals and families.

“Tampa General Hospital was just seven minutes away, so the paramedics got me there quick, and that saved my life.’’

But something else kept him motivated to live: “My spiritual belief pulled me through,’’ said the 60-year-old MD. “And my wife. If it wasn’t for her quick thinking, I might not be here today.’’

Dr. Rahul and Cathy Mehra

When the paramedics placed their patient into the ambulance, one of Dr. Mehra’s neighbors walked over to see what the commotion was about. She looked at him and held her hands together in prayer. In response, he gave her a thumbs up to say “I’m going to be ok.’’

And there was also COVID to consider: Both Dr. Mehra and Cathy had recently been vaccinated for COVID, but he still tested positive.

From there, it was up to a quickly assembled medical team at TGH to get Dr. Mehra back on his feet. Two days later, while in his hospital bed, Dr. Mehra suffered a second stroke.

Being a Saturday, some of the neurosurgery crew had to be called into work, led by Dr. W. Scott Burgin, Professor and Cerebrovascular Division Chief at the USF Health Morsani College of Medicine’s Department of Neurology and director of the Comprehensive Stroke Center at Tampa General Hospital.

“The nurse on shift found me unresponsive and alerted Dr. Burgin,’’ Dr. Mehra said.

The TGH team conducted a CAT scan and quickly identified the problem. “We converged on him within a matter of minutes, opened his artery back up and removed the clot in short order. Everyone worked as a finely tuned team,’’ Dr. Burgin said.

When news about Dr. Mehra’s failing health spread, three childhood friends flew to Tampa in a show of support. Each packed black clothing, “because they thought they were coming to a wake.’’

Rumors of Dr. Mehra’s passing were exaggerated and of course there was no funeral. In fact, he viewed what happened as a celebration of a renewed life.

“My recovery has been without any physical, sensory, or speech deficits,’’ he said. “The unparalleled recovery is the focus of the world-class care I received. Recall that three days after being found unconscious, paralyzed, blind and unable to speak in my hospital bed, I walked out of Tampa General’s Neuro ICU for discharge – not in a wheelchair but walking on my own strength.’’

Because a stroke cuts off blood and oxygen to the brain, it must be treated as an emergency. However, treatment is no easy task, Dr. Burgin said: A micro-catheter is inserted into the lower body and run upward to find the blockage in what may be a narrow blood vessel. “It’s like pushing a piece of string through the leg and up into the head.’’

More than 800,000 people a year in the United States suffer a stroke: enough to fill Tampa’s Raymond James Stadium 12 times over. Many of these people don’t know what hit them, and like Mehra, are in good health. This makes strokes difficult to predict and prevent. If not addressed quickly, a stroke can lead to brain hypoxia, permanent disability or death.

Stroke is among the top 10 leading causes of death in the United States:

• Heart disease
• Cancer
• Unintentional injuries
• Chronic lower respiratory disease
• Stroke and cerebrovascular diseases
• Alzheimer’s disease
• Diabetes
• Influenza and pneumonia

More on strokes: https://www.nhlbi.nih.gov/health/stroke

“Stroke is an incredibly under-resourced segment in medicine, even though it’s the No. 1 cause of disability and the No. 5 cause of death in the United States,’’ Dr. Burgin added. “We have heart centers everywhere, but not stroke centers.’’

For more about strokes and vascular neurology at USF, visit: https://health.usf.edu/care/neurology/services-specialties/stroke-vascularneurology

Story by Kurt Loft

The diagnostic blood test being developed is intended to speed treatment critical to improving  ischemic stroke outcomes

Stroke survivor Lauren Barnathan was one of the first patients to donate a blood sample for the pilot study of a stroke diagnostic test under development by VuEssence Inc and USF Health Neurology.

Lauren Barnathan, who routinely works with stroke patients as a speech pathologist at Tampa General Hospital, is athletic, maintains a healthy diet, and meditates.

And in January 2018, at age 30, she suffered a life-threatening stroke. A tear in the right carotid artery in her neck led to blood clot that dislodged, blocking blood flow to part of her brain.

Barnathan was among the first patients to donate a blood sample for a pilot-feasibility study teaming USF Health Neurology with VuEssence Inc., a Tampa Bay area medical device company with a laboratory based in the USF Research Park.  The ongoing study aims to develop a blood test that can accurately and rapidly detect when a person is having an acute ischemic stroke based on measurable biomarkers in the blood – and, ultimately, help guide treatment decisions for better outcomes.

“On the night of my stroke, when they were consenting me to be part of the study in the emergency department, I remember thinking how great it would be to have a test like that,” said Barnathan, whose fiancé Adam Barnathan, an ER medicine physician (now her husband), called 911 as soon he saw symptoms: facial droop and an inability to use one side of her body. Her timely and successful treatment at the TGH Comprehensive Stroke Center included the blood clot-dissolving drug tPA and a minimally-invasive procedure (mechanical thrombectomy) to physically retrieve a clot from the vessel blocked in her brain.

W. Scott Burgin, MD, professor and division chief of vascular neurology at USF Health Morsani College  of Medicine, leads the Comprehensive Stroke Center based at Tampa General Hospital.

A potential “game changer” for stroke neurology

No reliable early-detection test exists to identify a stroke – the fifth most common cause of death and the leading cause of long-term disability in the U.S.  Most strokes are ischemic, meaning that blood flow to the brain is obstructed by a clot in an artery. Once deprived of oxygen-rich blood, brain cells begin dying. And, stroke outcomes – including recovering the ability to walk, speak, see, understand, reason and/or remember — are generally worse the longer treatment is delayed.

“When I look at all the things that could change the way I’ve practiced stroke neurology all these years, this new diagnostic test would be one of the biggest game changers,” said W. Scott Burgin, MD, professor and division chief of vascular neurology at USF Health and director of its Comprehensive Stroke Center based at TGH.

A one-hour delay in treating stroke equals more than 450 miles of nerves cells, the approximate distance from Tampa to Atlanta, Dr. Burgin said. “And that’s a lot of brain tissue lost. So, any technology that can improve our ability to diagnose accurately and quickly would likely translate into a huge improvement in patients’ functional outcomes.”

USF engineering alumna Maha Sallam, PhD, is president and founder of VuEssence Inc., a Tampa Bay medical device company

Dr. Burgin (a clinical advisor to VuEssence) has been consulting with Maha Sallam, PhD, president and founder of VuEssence, on development of the early-detection stroke test. This applied research project between the university and industry partner VuEssence is funded in part by a Florida High-Tech Corridor Matching Grant, which supports stroke investigator efforts, scientific input into trial design and administration, and study logistics.

So far, about 200 blood samples have been collected for analysis from consenting patients who arrive at TGH’s emergency department with a suspected stroke, and the researchers plan to collect 200 more.

Doctors currently use clinical assessment, including a physical examination and obtaining a medical history, and brain imaging with MRIs and CT scans to assist with stroke diagnosis. Combined with ambulance transport to the hospital ER, these standard diagnostic methods can take hours, increasing the risk of serious brain injury.

“Getting someone treated within a short time period can be complex.” Dr. Burgin said.

Adding stroke-specific gene expression to diagnostic arsenal

Other diseases, such as low or high blood sugar, epilepsy, or migraines affecting one side of the head, can mimic stroke – and may need to be ruled out before specialized treatment by a multidisciplinary stroke team begins. And in the earliest stages of stroke, Dr. Burgin said, CT scans of the brain often appear essentially normal.

Blood samples are analyzed for stroke-specific gene expression at the VuEssence laboratory in USF’s Research Park.

“Right now, physicians really don’t know how the underlying biology in the body, the gene expression, is changing for a particular patient exhibiting acute stroke symptoms,” said Sallam, a USF graduate with a doctorate in computer engineering. “We hope to add that avenue of new information to existing diagnostic tools.”

VuEssence scientists analyze blood samples for specific products made by genes (gene expression) in response to the trauma happening in cells during stroke onset. Such genetic information may help doctors detect a stroke versus a condition that mimics stroke. The technology may also help differentiate the type of ischemic stroke – for example, indicate high probability of emergent large vessel occlusion that could benefit from a mechanical thrombectomy to remove the clot.

The company continues to reduce the time required to identify stroke-specific gene expression in the blood, with promising preliminary results, Sallam said. “Our goal is to get the system to process the patient’s blood (for stroke detection), so that critical test results are available less than 15 minutes” from the time blood is drawn.

To speed stroke treatment, diagnostic test results need to be available soon after a patient arrives at the hospital – if possible, even before.

Blood is collected from consenting patients who arrive at Tampa General’s emergency department with symptoms indicating high likelihood of stroke.

Long-term goal: Portable test device on ambulances

Both Sallam and Dr. Burgin agree that, ideally, the diagnostic blood test would be incorporated into an easy-to-use, portable device that paramedics and other first-responders could carry for pre-hospital detection and differentiation of strokes.

That would provide emergency medical services a much-needed tool to identify individuals with likely severe strokes, so those patients can be directly transported to the closest facility equipped for immediate endovascular therapy, Dr. Burgin said.

“If we get the test to work, the (long-term) goal would be to make it universally available on ambulances, whether in rural Montana or New York City,” he said. “In Montana, getting a patient to a specialized stroke center can be a significant endeavor. But, if the patient’s dizziness is caused by a stroke mimic, such as low blood sugar, they can probably go to the nearest hospital.”

First, though, VuEssense is focused on developing a streamlined test to be FDA approved and implemented in hospital settings and emergency departments, Sallam said. “If all goes well,” she added, “it will take some time before the point-of-care diagnostic technology could be available in ambulances.”

***

This February, Barnathan finished her first half-marathon at the Gasparilla Distance Classic in Tampa.| Photo courtesy of Lauren Barnathan

Barnathan, who overcame mobility and balance challenges after hospitalization, made virtually a full recovery. She returned to work about a month after her stroke, danced at her wedding several months later, and this February ran her first half-marathon, the Gasparilla Distance Classic, with her husband.

But in her professional role she sees stroke survivors who have not been as fortunate.

“Anything that can help expedite the process of intervening to minimize stroke damage would be a huge win,” she said.

Dr. Burgin with Tara McTigue, research nurse in the USF Health Department of Neurology

Dr. Sallam with Christy Larkins, PhD, a senior scientist at VuEssence

Lauren with her husband, Adam Barnathan, MD, an emergency medicine physician| Photo courtesy of Lauren Barnathan

-Photos by Allison Long, USF Health Communications and Marketing

Tampa, FL (Dec. 12, 2014) – The USF Health Morsani College of Medicine is conducting a clinical trial comparing the effectiveness of a new rapid-onset anticoagulant medication known as Apixaban with the standard anticoagulant drug warfarin in stroke patients with atrial fibrillation, the most common type of abnormal heart rhythm.

The investigator-initiated study is part of a $2.2 million research award from Bristol Myers Squibb awarded to Arthur Labovitz, MD, professor and chair of the Department of Cardiovascular Sciences for the USF Health Morsani College of Medicine and director of Non-Invasive Cardiology at Tampa General Hospital.

USF Health cardiologist Dr. Arthur Labovitz, principal investigator for the AREST study.

Dr. Labovitz is the principal investigator for the study, which is called “Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation,” or AREST. The study is the part of the USF Health Heart Institute, which is co-directed by Dr. Labovitz.

Anticoagulant therapy lowers the risk of strokes caused by embolisms (blood clots) in patients with atrial fibrillation, but its use is associated with potentially deadly bleeding. The new randomized trial will evaluate whether early treatment with Apixaban, an alternative requiring less monitoring and re-dosing than warfarin, can prevent recurrent strokes and reduce the risk of brain bleeding in patients who have suffered a first embolic stroke.

“Current guidelines suggest delaying treatment for patients with atrial fibrillation who have had a stroke, often times for two weeks or more,” Dr. Labovitz said. “This commonly results in poor outcomes in these individuals. The AREST study will more aggressively treat these patients earlier, sometimes within 24 hours of symptoms, in order to improve their outcomes. The protocol tests the hypothesis that one of the newer blood thinners, Apixaban (Eliquis), will be safe and effective in this regard.”

Early research showing that the risk of intracranial bleeding is markedly reduced (50 percent) with the new oral anticoagulant prompted him for initiate and develop the AREST study, Dr. Labovitz said.

In the USF AREST study, researchers will give either warfarin or Apixaban to 120 adult patients admitted to Tampa General Hospital with a transient ischemic attack (TIA) or small to medium ischemic stroke, who also have a history of, or current diagnosis of, atrial fibrillation. Atrial fibrillation is a common cause of stroke.

Patients will be randomly given the medications within 48 hours of stroke symptom onset and then followed for 180 days to compare the incidence of recurrent stroke, death or intracranial hemorrhage.

USF Health’s Dr. Scott Burgin directs the TGH Comprehensive Stroke Center and is a co-investigator for the AREST study.

“This study could answer a question that has long been undefined, and that is the optimal timing for giving anticoagulant medication after having an acute stroke,” said W. Scott Burgin, MD, professor of neurology and chief of the USF Cerebrovascular Division in the USF Health Morsani College of Medicine, director of the HFAP Certified Comprehensive Stroke Center at Tampa General Hospital, and a co-investigator for the AREST study.

“This new anticoagulant medication is already showing a greater effectiveness and a higher safety profile so starting the medication sooner than the standard 14 days could improve outcomes for stroke patients.”

Dr. Labovitz (left) and co-investigator Dr. David Rose stand in the heart of the Neurosciences Intensive Care Unit at TGH. The researchers will track stroke patients taking the new anticoagulant for the AREST study.

Co-Investigators for the USF AREST study, who are all USF Health faculty, are Dr. Burgin; David Rose, MD, assistant professor of Neurology and medical director, Neuro-ICU at TGH; Sanders Chae, MD, JD, assistant professor of cardiology; Michael Fradley, MD, assistant professor of cardiology; Theresa Beckie, PhD, professor in the USF Health Morsani College of Medicine and the USF College of Nursing; Waldo R. Guerrero, MD, assistant professor of vascular neurology; and Ryan Martin, MD, a fellow in the USF Department of Cardiovascular Sciences.

For more information about the AREST clinical trial at USF Health, please contact Bonnie Kirby, MSN, RN, research administrator for USF Cardiovascular Sciences, at bkirby@health.usf.edu or call (813) 259-8543.

About USF Health

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit www.health.usf.edu

]]> https://hscweb3.hsc.usf.edu/blog/2014/12/09/tampa-general-hospital-among-elite-stroke-centers-country/ Tue, 09 Dec 2014 19:24:45 +0000 https://hscweb3.hsc.usf.edu/?p=12965 USF stroke experts staff the TGH Stroke Center, providing patients in the Tampa Bay region with 24/7 access to more specialized stroke care, including on-site neurosurgeons and medical teams […]

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USF stroke experts staff the TGH Stroke Center, providing patients in the Tampa Bay region with 24/7 access to more specialized stroke care, including on-site neurosurgeons and medical teams trained in neurocritical care.

TAMPA, FL (Dec. 8, 2014) – Tampa General Hospital is the first hospital on the west coast of Florida to be awarded Comprehensive Stroke Certification, the highest national designation from the Healthcare Facilities Accreditation Program, a national certification organization recognized by the federal Centers for Medicare and Medicaid Services.

The new state-of-the-art Bayshore Pavillion at TGH has a dedicated Stroke Unit, a Trauma Resuscitation Unit and full capability CT and MRI scan in the Emergency Department; dedicated neuroangiography suites; and a Neurosciences Intensive Care Unit, which is one of the largest in the country.

This elite designation means the hospital meets the highest standards for safety and quality and can treat patients 24 hours a day with the most complex state-of-the-art stroke care.  Tampa General earned the national designation by meeting 21 evidence-based measures of complex stroke care. Continuous on-site neurologists, neurosurgeons, diagnostic radiologists and medical teams trained in neurocritical care are ready to treat emergencies immediately with highly trained and qualified nursing staff. Studies show that stroke patients have better outcomes when these standards are met.

“This provides an external validation for what we’ve known for a long time,” said Dr. W. Scott Burgin, director of Tampa General’s Comprehensive Stroke Center and professor of Neurology and chief of the Cerebrovascular Division at the USF Health Morsani College of Medicine.

“We are providing the highest level of care for our patients at Tampa General. Every stroke is different, and sometimes there are complications that require extremely specialized care that can only be found at comprehensive centers with a team on hand 24 hours a day who are trained to handle those complications.”

USF Health’s Dr. Scott Burgin directs the TGH Comprehensive Stroke Center.

Tampa General is the fourth hospital in the state to receive this national designation for its stroke program. It also is one of 34 Florida hospitals designated as a state Comprehensive Stroke Center, and one of 124 that the Joint Commission certifies as a Primary Stroke Center.

“This certification signifies that Tampa General Hospital has demonstrated and is clearly committed to advancing stroke treatment through innovation and best practice – placing them amongst world leaders,” said Michael Zarski, chief executive officer of HFAP. “Hospitals that have established stroke centers have demonstrated improved treatment, better patient outcomes, and reduced costs. In addition, Comprehensive Stroke centers are a resource to both the community and neighboring hospitals who are not equipped to offer the same level of care.”

Strokes occur when blood flow is disrupted in the brain. A clot can block a blood vessel, or bleeding can occur. If brain cells can’t receive blood and oxygen, they start to die, causing permanent damage. About 795,000 Americans have a stroke each year, making stroke the 4th leading cause of death in the U.S.

A stroke requires immediate emergency treatment and every minute counts. You can use the “FAST” acronym to recognize warning signs of a stroke: “Face drooping, Arm weakness, Speech difficulty, Time to call 911.”

-Tampa General Hospital-

Tampa General is a 1018-bed academic medical center on the west coast of Florida that serves as the region’s only center for Level l trauma, comprehensive burn care, and adult solid organ transplants. It is the primary teaching hospital for the USF Health Morsani College of Medicine. TGH is a comprehensive stroke center and a state-certified spinal cord and brain injury rehabilitation center. For more information, go to www.tgh.org.