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Health Information Stroke Care

Minding Your Gray Matter

For James Burns, the numbness he felt in his right leg and arm late last winter was all too familiar. Just a year before, he had suffered a stroke — a “brain attack” caused by an obstruction or rupture that prevents blood flow to the brain — and experienced similar symptoms.

This time, Burns was brought to Rush University Medical Center. And because of that, he considers himself extremely lucky. It wasn’t Rush’s anticipated certification this year as a primary stroke center by the Joint Commission, which evaluates and accredits health care organizations around the country, that made him feel lucky. Nor was it that Rush rates among the top 3 percent of programs approved by the Commission on Accreditation of Rehabilitation Facilities.

In fact, Burns wasn’t even aware of these distinctions when he arrived in the Rush emergency room. Rather, Burns’ experiences during his stay at Rush convinced him that Rush was the right place for his care, not just for his stroke and rehabilitation but for his ongoing, overall health needs.

Watching the Clock

The moment Burns came to Rush, the emergency stroke response team jumped into action.

“When stroke is suspected, time is of the essence,” says Vivien Lee, MD, a stroke neurologist who treated Burns. “Millions of brain cells die every minute a stroke goes untreated.”

That’s why Rush follows a timed, standardized set of procedures, which requires that diagnostic tests, such as computed tomography (CT) scans and blood work, be given and evaluated immediately.

Since tests indicated that Burns was having a transient ischemic attack, or TIA (a mild stroke in which the blockage resolves itself), doctors placed Burns on cholesterol-lowering medications and aspirin to prevent blood clots and reduce his risk of having another TIA.

Had Burns’ condition been more serious, the stroke team would have intervened with one of the many treatment options at their disposal. These include tissue plasminogen activator (TPA), a medication that dissolves blood clots, as well as novel procedures in which catheters are threaded through the arteries in an attempt to remove the clot and restore blood flow to the brain.

Because early intervention benefits patients in the long run, rehabilitation specialists met with Burns within 24 hours of his admittance to the Stroke Care Unit to determine his needs and start him working on the basics, such as sitting up and getting in and out of bed.

“Through it all, the staff at Rush clearly explained to me what was being done and why,” Burns says.

This ongoing communication, which included educational pamphlets about stroke, eased Burns’ anxiety and motivated him in the recovery process.

A Team Approach to Recovery

Burns’ multidisciplinary rehabilitation team, led by Christopher Reger, MD, a physical medicine and rehabilitation specialist at Rush, met twice a week to establish his treatment goals.

During his stay in Rush’s rehab unit, they took an aggressive approach — which has been shown to produce better results — to helping him regain strength, mobility and balance on his right side and improve his speech. Each day Burns completed two hours of physical therapy, one hour of occupational therapy and one hour of speech therapy.

To help Burns and patients like him, therapists at Rush have many tools in their arsenal, including equipment to help with gait and balance; new devices like Bioness, a splint-like apparatus that uses electrical stimulation to help reduce stiffness and increase range of motion in the arms and legs; and a simulated grocery store and bedroom where patients practice everyday tasks.

“Our goal is to get patients home and back to their daily routines,” Reger says.

Although he found the experience grueling, Burns grew to appreciate the dedication of the staff and the compassion with which they provided therapy. He quickly developed a rapport with the team, teasing them by jokingly assigning nicknames, like “the assassinator” for his physical therapist.

A More Complete Continuum of Care

Over the years, patients like Burns have voiced a desire to continue their rigorous rehabilitative care at Rush after their hospital stay is over. In response, Rush opened an adult day program last spring.

This intense outpatient therapy program is designed for patients who require more than one kind of rehabilitative therapy. Today, Burns is back at work as a union representative, but his relationship with Rush is far from over. He now sees an internist and a nutritionist at Rush, who help manage his blood pressure and weight. As much as he appreciated his experience at Rush, he wants to make sure he doesn’t end up back in the emergency room.

The Head-Heart Connection

A Possible Link Between Strokes, A Heart Defect and Migraines

A treatment that prevents strokes in some patients appears to have an unexpected benefit — it may also eliminate or reduce migraine headaches in patients with a certain heart defect.

For several years, doctors worldwide have heard from migraine sufferers who said their headaches abated after they had a stroke-related heart defect repaired using an experimental, nonsurgical procedure.

Now, Clifford Kavinsky, MD, PhD, a cardiologist at Rush University Medical Center, and researchers from 14 other U.S. medical facilities are conducting a yearlong study to scientifically evaluate those cases.

If those patients are right, the key to some migraines apparently rests in the heart — not the head.

The focus is on a tiny opening between the heart’s top two chambers, called a patent foramen ovale (PFO). This opening usually exists only in a developing fetus, to make blood circulation more efficient. Soon after birth, it usually closes.

In about 25 percent of adults, however, the opening remains. Normally, this is harmless. Sometimes, though, a small blood clot crosses from the right side of the heart to the left and from there travels to the brain, where it can cause a stroke.

Patients who have had one of these strokes sometimes undergo a procedure to seal the opening, which reduces the risk for future strokes. For unknown reasons, some of these stroke patients who also had migraines found that the procedure dramatically reduced headaches as well. If researchers can document these claims, it could lead to effective treatment for these particular migraine patients.

“Life is miserable for migraine sufferers,” Kavinsky says. “If we could help some of these people, we could make a big difference in their lives.” The study, known as MIST II, includes about 600 people with both migraine headaches and the heart abnormality. Half will have the abnormality repaired, while the other half will not.

The procedure employs a tiny device shaped like two open umbrellas joined at the handles that is placed in the heart via tubes extending up from veins in the leg.

After the procedure, patients will report each month on migraine frequency, intensity and duration. Researchers will compare the groups after one year.

“There’s a lot we don’t understand about migraines,” Kavinsky says. “But this study should help us learn more and perhaps ultimately ease the suffering of thousands of people who have migraines related to this heart abnormality.”

MIST II is expected to enroll about 15 patients at Rush. If you’re interested in participating, contact Christina Giannoulis at (312) 942-9489 or e-mail clinical_trials@rush.edu. For more information, go to Clinical Trials at Rush.


 

Stroke Care at Rush

The Stroke Center at Rush University Medical Center in Chicago, Illinois, provides comprehensive medical treatment for stroke and related conditions, from immediate treatment for people experiencing a stroke to specialized follow-up care for those coping with the aftermath of a stroke or stroke-related condition.

Because Rush is an academic medical center, patients often have access to investigative therapies and treatment approaches for stroke that are not widely available.

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