VOL. 11 | ISSUE 2
NEUROSCIENCE OUTLOOK
NEWS AND RESEARCH FROM THE DEPARTMENTS OF NEUROLOGY AND NEUROSURGERY AT GEORGIA REGENTS NEUROSCIENCE CENTER
CAVERNOUS MALFORMATIONS
Image-guided navigation to reach deep lesions has improved the safety of surgery
FROM THE CHAIRMEN
DEPARTMENT NEWS
Cargill H. Alleyne Jr., M.D., and David C. Hess, M.D.
In this issue of Neuroscience Outlook, we highlight cavernous malformations, an interesting subtype of vascular malformations. These lesions, especially those that are deep-seated such as those located in the brainstem, present a difficult treatment dilemma. The use of image-guided and skullbase techniques has improved the outcomes in patients undergoing surgical resection. We also describe the new Cognitive and Memory clinic, a natural extension to the wellestablished and renowned Movement Disorders program. In addition, we introduce the Spinal Radiosurgery program, which is a collaborative effort between the departments of Radiation Oncology, Neurology, and Neurosurgery. Our collaboration with local and regional facilities continues with new appointments in both the Neurosurgery and Neurology departments. We are proud of the continued rise in the Neurosurgery department’s rank in NIH funding to 17th. The credit for this rise goes to our dedicated researchers and the close working relationship they have with our clinical faculty. The resultant translational projects have borne significant fruit. Finally, we list the honors and awards garnered by the faculty of both departments. Cargill H. Alleyne Jr., M.D. Professor and Marshall Allen Distinguished Chair of Neurosurgery calleyne@gru.edu
David Hess, M.D. Professor and Presidential Distinguished Chair of Neurology dhess@gru.edu
NEUROSCIENCE OUTLOOK A publication of the Georgia Regents University Departments of Neurology and Neurosurgery Editor-in-chief: Cargill H. Alleyne Jr., M.D. Editor: Phil Malkinson Illustrations: Colby Polonsky, M.S. Contributors: Elizabeth Prince Coleman, PA-C; John C. Morgan, M.D., Ph.D.; Scott Y. Rahimi, M.D.; Cargill H. Alleyne Jr., M.D.
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James D. Dillon, M.D., has received an appointment in the GRU Neurosurgery department.
Gregory Sengstock, M.D.
Welcome aboard James Daniel Dillon, M.D., given appointment in GRU Neurosurgery
New neurology faculty to join affiliated hospitals
Neurosurgeon Dr. Jim (“Dan”) Dillon, who has practiced at Aiken Regional Medical Center (ARMC) in Aiken, South Carolina, since 2010, was recently granted appointment as Assistant Clinical Professor in the GRU Department of Neurosurgery. This appointment is a reflection of the close relationship between ARMC and GRU. Dr. Dillon completed his residency at Vanderbilt University in 1977, served in both the U.S. Navy and Army, and practiced in Virginia Beach before moving to Aiken in 2010.
Gregory Sengstock, M.D., will begin practice at Aiken Regional Medical Center (ARMC) in June 2014 and will be the Neurology department’s first full-time faculty member in Aiken. He will join Dan Dillon, M.D., from Neurosurgery to provide both our departments and our Neuroscience Center a presence at Aiken Regional. In July 2014, three new neurologists will start working at our St. Joseph’s Candler (SJC) campus in Savannah. Jonas Vanags, M.D., presently a Neuromuscular Fellow at Duke University and a graduate of the Medical College of Georgia, will direct the Neuromuscular Program at SJC. Brian Raj, M.D., currently chief resident at Duke University, will work as a Neurohospitalist. Jeff Borkoski, M.D., presently in practice in New Smyrna Beach, Florida, will work in the outpatient clinic.
Neurosurgery faculty wins award
Krishnan Dhandapani, Ph.D., Associate Professor in the department of Neurosurgery, was one of 20 alumni leaders from Georgia Regents University who won an inaugural Jag20 award. The awards recognize alumni under age 40 who have made a significant impact in their career, community, and the university.
Focused radiation for the spine— new frontiers The GRU Cancer Center’s Radiation Therapy program and the departments of Neurosurgery, Neurology, and Radiology have initiated an exciting treatment for patients with spinal tumors. Th is treatment provides effective tumor control when more conventional radiotherapy has failed. Spinal radiosurgery can also provide faster and more durable pain control. The treatment utilizes an advanced linear accelerator to precisely deliver high doses of radiation to tumors ranging from benign to malignant—including primary and secondary tumors—and ensures that the surrounding organs receive only minimal doses. Stereotactic spinal radiosurgery usually delivers one single fraction of a very high dose compared to multiple fractions (up to 40) of low radiation doses in conventional radiotherapy. The treatment takes only a few days in contrast to conventional modalities that may take weeks. Look for more detailed case illustrations in our next issue of Neuroscience Outlook.
Neurosurgery department vaults to 17th place in NIH funding
In 2013 and with $935,040 in NIH funding, the Neurosurgery department ranked 17th (out of 42 neurosurgery departments listed and out of 105 neurosurgery departments in the U.S.) in the NIH research Blue Ridge rankings. This ranking represents a rise from 39th in 2004 and a jump from 28th last year. The department also has a variety of non-NIH funding (including American Heart Association) that contributes to our research enterprise. We hope to continue this ascent in the future.
TRANSITIONS
Transition in Neurology residency program director After 14 years of directing the Neurology Residency Program, Ned Pruitt, M.D., will step down for a rest and take on other duties in the department. Our new Residency Director, effective July 1, 2014, will be Askiel Bruno, M.D.
Comprehensive stroke center
Ned Pruitt, M.D.
Physician’s home
OR OTHER 3 RD SITE
HUB
A 58-year-old patient with a history of breast cancer presented with severe back pain and a newly metastatic tumor to the lumbar spine. She underwent spinal radiosurgery (Varian system) with 7 GY x 5 fractions normalized to the 95 percent isodose line.
SPOKE
Rural hospital
Askiel Bruno, M.D.
REACH network expands Our REACH telestroke network continues to expand. In February 2014, we added University Hospital in Augusta, Georgia. The network now includes 30 “spoke” hospitals.
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CLINICAL SPOTLIGHT
Cavernous malformations
Image-guided navigation has enhanced the safety of surgery on cavernous malformations Cargill H. Alleyne Jr., M.D., and Scott Rahimi, M.D.
1a
Cavernous malformations are a subset of vascular malformations that also include arteriovenous malformations, capillary telangiectasias, and venous malformations. In the literature they have also been referred to as “cavernous angiomas,” “cavernous hemangiomas,” “cavernomas,” and “cavernous venous malformations.” The prevalence is approximately 0.4–0.5 percent. Patients can present with seizures, focal neurologic deficits, bleeds, or headaches, but a significant proportion are asymptomatic. The risk of symptomatic hemorrhage is 1 percent per year. The lesions are well-circumscribed, consisting of closely packed, thin-walled sinusoids without intervening neural parenchyma. Grossly, they appear dark red to purple and are often described as “mulberry-like” in appearance. They range in size from a few millimeters to several centimeters and often show evidence of hemosiderin staining. They can occur anywhere in the CNS, but their 1b
location is roughly proportional to the volume of the CNS compartment (i.e., the frontal lobe is the most common location). Intraoperative measurements show that the intravascular pressures are midway between venous and arterial pressures. Microscopic findings include a network of thin-walled vascular channels arranged in a back-to-back pattern, walls lined by a single layer of endothelium, and a central fibrotic, organized thrombus. They are also characterized by abundant hemosiderin, which is a deposition of iron salts that can predispose to epileptogenic activity, as well as focal areas of calcification, edema, and gliosis. Lesions are thought to grow as a result of recurrent hemorrhages. Some lesions have a more aggressive course secondary to hemorrhage outside the capsule. They may co-exist with other malformations, notably developmental venous anomalies, which are not pathologic and must be preserved at all costs during surgical resection. Cavernous malformations occur in two forms. Sporadic malformations are typically solitary and are more common. Familial lesions are often multiple lesions and associated with a strong family history. Much work has been recently done on the genetics of cavernous malformations. Thus far there have been at least three separate gene mutations identified in the familial form. CCM-1 is associated with the protein Krit-1, a defect at gene locus Figures 1a and b. Axial T2 and sagittal T1 MRI revealing cavernous malformation in the medulla.
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1c
7q21.2, and is common in the Hispanic population. CCM-2 is associated with the protein malcavernin and a defect on 7p13. CCM-3 is associated with PDCD10 and a defect on gene 3q26.1. They are inherited in an autosomal dominant pattern with variable penetrance, but only 60 percent are clinically symptomatic. Cavernous malformations were traditionally considered to be congenital lesions and cases in neonates have been reported, but it is very clear that these lesions can also arise de novo, as initially well documented in familial cases. Although cavernous malformations have been known since the 1930s, it was not until the advent of MR imaging in the 1980s that they were reliably diagnosed antemortem. Serial MR imaging is used to assess changes in the size of known lesions, identify new bleeds, and monitor the appearance of new lesions. Surgery is generally indicated for accessible lesions that have repeatedly bled, are enlarging, or demonstrate progressive neurologic deficit. While surgery on cavernous malformations of the brainstem or spinal cord is riskier, the natural history of these lesions may be worse. Surgical treatment has been made safer
Figures 1c and d. Postoperative axial T2 and sagittal T1 MRI showing gross total resection.
1d
by using image-guided navigation to reach the lesion with minimal disruption to the surrounding normal tissue. The role of stereotactic radiosurgery in the treatment of these lesions is controversial and remains to be elucidated. CASE ILLUSTRATIONS Case 1—The patient is a 51-year-old woman initially diagnosed with a TIA in 2007 when she developed tingling and numbness in the right hand. In September 2011, she developed increasing weakness, gait instability, and numbness. An MRI showed a cavernous malformation of the medulla (figures 1a and 1b). Upon presentation to our institution, she had a right hemiparesis in the upper and lower extremities with tongue deviation to the left. She underwent a posterior fossa craniotomy with Stealth guidance. Figures 1c and 1d show the postoperative imaging. She tolerated the procedure well and was discharged home on postoperative day number six. By her one-month follow-up visit, her preoperative hemiparesis had already improved, and at six months she was ambulating without assistance.
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CLINICAL SPOTLIGHT
Case 2—The patient is a 73-year-old man with a 10-year history of progressive left arm and leg weakness and gait instability. His MRI revealed a left pontomedullary cavernous malformation exophytic into the fourth ventricle (figures 2a and 2b). He underwent a Stealth-guided craniotomy, which he tolerated well. Figures 2c and 2d show the intraoperative findings. Postoperative imaging is shown in figures 2e and 2f. Postoperatively he developed new diplopia, which persisted at the onemonth follow-up visit. His preoperative hemiparesis was stable at the six-month follow-up visit, and his diplopia had improved greatly.
2b
2a
Figures 2a and b. Axial T2 and coronal T1 MRI revealing cavernous malformation at the pontomedullary junction. Figures 2c and d. Intraoperative view of the fourth ventricle with hemosiderin staining of the floor (2c) and upon entry into the lesion (2d).
Figures 2e and f. Postoperative axial T2 and coronal T1 MRI shows gross total resection.
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2d
2c
2e
NEUROSCIENCE OUTLOOK Volume 11 | Issue 2
2f
CLINICAL SPOTLIGHT
Cognitive and Memory Clinic The Department of Neurology of Georgia Regents University announces our new Memory Disorders Program. Led by John C. Morgan, M.D., Ph.D., and Elizabeth Prince-Coleman, PA-C, this program aims to serve patients and families battling Alzheimer’s disease (AD) and other cognitive disorders. With state-of-the-art interdisciplinary and family-centered care, we hope to provide the tools necessary for patients and caregivers to improve outcomes and overall quality of life. We also work closely with the local Alzheimer’s Association to connect our patients with the
Offering comprehensive diagnostic evaluation and state-of-the-art interdisciplinary care Elizabeth Prince-Coleman, PA-C, and John C. Morgan, M.D., Ph.D.
full scope of community resources. Dr. Morgan has long been a key member of our Movement Disorders Program, led by Kapil Sethi, M.D., FRCP (UK). Under Dr. Sethi and Dr. Morgan, our Movement Disorders Program has long been designated a National Parkinson Foundation Center of Excellence, leading in patient care, research, and education. As treating cognitive symptoms is often a critical component of comprehensive care in Parkinson’s disease, Dr. Morgan’s experience offers a natural expansion of the practice to include those with primary memory and cognitive complaints. Elizabeth
Th e Georgia Regents University Memory Disorders Team: Elizabeth Prince-Coleman, PA-C; John C. Morgan, M.D., Ph.D.; Cat Rucker; and Greg Lee, Ph.D.
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CLINICAL SPOTLIGHT
NF Tangles
Neuritic plaques
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Prince-Coleman, PA-C, assists Dr. Morgan in the clinic and ensures that patients and caregivers have access to the resources they need. Elizabeth Prince-Coleman has received accolades in compassionate patient care (John F. Beard Award in 2013 and Raymond C. Bard Award in 2012) and helps tremendously with patient and caregiver education and follow-up. Our administrative assistant, Cat Rucker, serves as a first-line point of contact for our families attending the clinic. She has proven herself an invaluable resource to our movement disorder patients over the past five years. The Memory Disorders Program is dedicated to offering our patients the best in diagnostic evaluation, from imaging to neuropsychological testing. We have the ability to perform PET scans that can define glucose metabolism and measure amyloid deposition in the brain through GRU’s Nuclear Medicine Program. Gregory Lee, Ph.D., ABPP, director of our Adult Neuropsychology Service, provides decades of experience in cognitive testing with considerable experience in dementia and other cognitive disorders. We are aggressively pursuing research in Alzheimer’s disease and cognitive disorders with a goal of improving local access to both investigator-initiated and pharmaceutical company-based clinical trials. With a strong, compassionate team experienced in diagnostic, clinical, and investigative aspects of patient care, we are confident our Memory Disorders Program will soon become a leader in the Southeast.
Figure 1. ß-amyloid plaques are indicated and there are clumps of protein outside of degenerating nerve cells in this picture. Neurofibrillary tangles are made of a protein inside nerve cells called tau and they are also seen in Alzheimer’s disease and other dementias.
CASE ILLUSTRATION In the interest of patient confidentiality, the following is a composite history representative of the patients we see. The patient, Tom, is a 75-yearold retired teacher who gradually developed progressive memory impairment that was of increasing concern to his family. He was largely
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unaware of his deficits in thinking and memory. He and his wife went to their primary care provider, Dr. Williams, and there were no obvious new physical findings, medication changes, or laboratory abnormalities that could explain his decline. His wife had noticed more trouble with recent memory and forgetfulness related to recent conversations. His daughter noticed he had trouble with finances and difficulty driving, especially if he was in an unfamiliar place. His mother lived to age 85 and suffered with Alzheimer’s disease (AD) for the last five years of her life, so there was significant concern that Tom was also developing dementia. Dr. Williams referred the patient and his family to the Memory Disorders Clinic at GRU and he saw Mrs. Prince-Coleman and Dr. Morgan for an initial evaluation. He underwent routine laboratory testing for reversible causes of dementia, had a brain MRI, and had neuropsychological testing with Dr. Greg Lee at GRU. The brain MRI showed only minor findings (no signs of significant strokes) and his laboratory testing for reversible causes of dementia was normal. Neuropsychological testing showed significant memory/cognitive problems (consistent with what the family had observed) and was consistent with early AD given the clinical picture. They returned to see Mrs. Prince-Coleman and Dr. Morgan, and while the news was somewhat expected, it was difficult to accept. His wife wanted him to have the “new Alzheimer’s scan,” which images the brain for a major component of the brain degeneration in Alzheimer’s disease, ß-amyloid plaques. He came to the Nuclear Medicine Imaging Center at GRU, had an injection of the FDA-approved imaging agent florbetapir, and his brain was imaged with a PET scan. The scan did show an abnormal amount of ß-amyloid in the brain compared to what a cognitively normal elderly person’s brain would show. Figure 2 shows the PET/CT imaging from an actual patient with typical findings. After having the PET scan and a firm diagnosis of AD from multiple perspectives (clinical impression, neuropsychological testing, and imaging), the patient and his family accepted the diagnosis and wanted to pursue treatment and research. Dr. Morgan offered them an FDA-approved medication that will increase acetylcholine in the brain by inhibiting its breakdown, and counseled them about potential side effects. He tolerated the medication well and there were no significant side effects. For support and education of both the patient and family, they were referred to the Alzheimer’s Association (alz.org) locally where Kathy Tuckey and colleagues helped provide
FACULTY & STAFF UPDATES 2a
3a
Krishnan Dhandapani, Ph.D., (Department of Neurosurgery) served as Chair of the American Heart Association Brain 2 Panel. He also won a Jag20 Emerging Alumni Leader Award from Georgia Regents University.
2b
Sergei Kirov, Ph.D., (Department of Neurosurgery) was a reviewer on the American Heart Association Peer Review Committee: BrainStroke Basic Science 5.
3b
Deborah MooreHill, M.D., (Department of Neurology) passed her American Board of Psychiatry and Neurology (ABPN) clinical neurophysiology and ABPN epilepsy boards. Subhashini Ramesh, M.D., (Department of Neurology) passed her UCNS Neurocritical care boards in February.
RESIDENT AND STUDENT UPDATE
4a
Forrest Andersen, a second year medical student who was an American Heart Association Scholar and GRU Medical Scholar, presented a paper entitled Effect of remote limb ischemic conditioning on CBF as measured by arterial spin labeling in human stroke at the American Stroke Association–International Stroke Conference in San Diego in February.
4b
THANKS TO OUR DONORS
outstanding education and support for living well with AD. He was referred for a driving safety evaluation with our therapists and it was recommended that he let his wife do the driving from this point forward. The patient and his family were approached about a clinical trial in AD and they were enrolled in a study at GRU to determine if a new therapy provided cognitive or disease-slowing benefits in AD. He and his family felt good knowing that his participation in clinical trials may lead to better treatments or a future cure for AD. While everyone’s journey with dementia is different, we hope that we can help your patients live better with dementia, whether due to AD or other causes.
Figures 2–4. A 67-yearold male with dementia, a negative MRI, and an atypical presentation for AD, including episodic memory impairment, emotional blunting, disinhibition, dyspraxia, and anomia received 10 minute PET/CT imaging. 2a and b. Cortical amyloid deposition, left temporal lobe. 3a and b. Cortical amyloid deposition, parietal lobes and right frontal lobe. 4a and b. Normal white matter amyloid deposition.
Aiken Technical College Foundation Vincent Alewine Janelle M. Allen Association of Georgia Inc. Myrtle G. Berry Berry Black Eileen V. Brandon Rita C. Bumpas Raymond R. Campbell Lyndon R. Carey Haroon F. Choudhri William B. Clark Pamela S. Coffey Lance N. DeLoach Arnold T. Dobran Dynavox Systems LLC Ernest Fokes Donnis S. Fowler Franklin Foundation Group & Benefits Consultants David H. Hock Leonard D. Hogan
I.U.O.E. Local 470 Jeep Masters of Augusta Kenneth Jeffcoat Segal Johnson Furman Knight Medical Services of America Medtronic Betty C. Moak Roger Noel Onofre Paguio Pepsico Foundation Laree Prather Forrest E. Roberts Lisa Rupp Austin B. Scott Kapil D. Sethi The ALS Association John R. Vender ViaCord Blandena T. Wall Jack M. Willis Mary Wright
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PUBLICATIONS & PRESENTATIONS
January–April 2014 PUBLICATIONS Van Rompaey J, Bush C, Khabbaz E, Vender JR, Panizza B, Solares CA What is the best route to the Meckel Cave? Anatomical comparison between the endoscopic endonasal approach and a lateral approach. J Neurol Surg B Skull Base 74:331-6, 2013 [DOI: 10.1055/s-00331342989]. King MD, WhitakerLea W, Campbell JM, Alleyne CH, Dhandapani KM Necrostatin-1 reduces neurovascular injury after intracerebral hemorrhage. Int J Cell Biol, March 2014 [DOI:10.1155/2014 /495817]. Alleyne CH Subarachnoid hemorrhage and intracranial aneurysms. Audio-Digest Neurology, Volume 05, Issue 07, April 7, 2014. Villarreal N, Riccio CA, Cohen MJ, Park Y Adaptive skills and somatization in children with epilepsy. Epilepsy Research and Treatment, Vol. 2014, Article ID 856735, 7 pages, 2014. [doi:10.1155/2014 /856735]. Laird MD, Shields JS, Sukumari Ramesh S, Kimbler DE, Fessler RD Youssef P, Shakir B, Yanasak NE, Vender JR, Dhandapani KM High mobility group box protein 1 promotes
PRESENTATIONS cerebral edema after traumatic brain injury via activation of toll-like receptor 4. Glia 62:26-38, 2014.
post-ischemic stroke biomedical pig model. Physiol Behav 125:816, 2014 [doi: 10.1016/j. physbeh.2013.11.004].
Platt SR, Holmes SP, Howerth EW, Duberstein KJ, Dove CR, Kinder HA, Wyatt EL, Linville AV, Lau VW, Stice SL, Hill WD, Hess DC, West FD Development and characterization of a Yucatan miniature biomedical pig permanent middle cerebral artery occlusion stroke model. Exp Transl Stroke Med 6:5, 2014 [doi: 10.1186/2040-7378-6-5].
Mehta SH, Switzer JA, Biddinger P, Rojiani AM IgG4-related leptomeningitis: A reversible cause of rapidly progressive cognitive decline. Neurology 82:540-542, 2014.
Hoda MN, Bhatia K, Hafez SS, Johnson MH, Siddiqui S, Ergul A, Zaidi SK, Fagan SC, Hess DC Remote ischemic perconditioning is effective after embolic stroke in ovariectomized female mice. Transl Stroke Res., 2014 January 4. [Epub ahead of print]. Savitz SI, Cramer SC, Wechsler L STEPS 3 Consortium: Stem cells as an emerging paradigm in stroke 3: enhancing the development of clinical trials. Stroke 45:634-9, 2014 [doi: 10.1161/ STROKEAHA.113.003379]. Duberstein KJ, Platt SR, Holmes SP, Dove CR, Howerth EW, Kent M, Stice SL, Hill WD, Hess DC, West FD Gait analysis in a pre- and
Singh R, Mathiassen L, Switzer J, Adams R Assimilation of webbased urgent stroke evaluation: A study of two networks. JMIR Med Inform 2:e6:1–13, 2014. Woodall MN, Shakir B, Smitherman A, Choudhri HF Technical note: Resolution of spontaneous electromyographic discharge following disk space distraction during lateral transpsoas interbody fusion. Int J Spine Surg 7:e3941, 2013. Ergul A, Abdelsaid M, Fouda AY, Fagan SC Cerebral neovascularization in diabetes: implications for stroke recovery and beyond. J Cereb Blood Flow Metab 34:553-63, 2014.
Alleyne CH Neurosurgery. Management 4950 lecture, Hull College of Business, Georgia Regents University, February 2014 Woodall MN Training in Neurosurgery. Management 4950 lecture, Hull College of Business, Georgia Regents University, February 2014 Andersen FS, Forseen S, Yanasak N, Gilbert BC, Switzer JA, Nichols FT, Bruno A, Jacob S, Brian Close, Kim A, Hoda N, Hess DC Effect of remote limb ischemic conditioning on CBF as measured by arterial spin labeling in human stroke. American Stroke Association– International Stroke Conference, San Diego, Calif., February 2014 Hoda N, Khan MB, Wakade CG, Ergul A, Fagan SC, Hess DC Remote ischemic conditioning (RIC), a combined regimen of per- and postconditionings (RIPerC and RIPostC), provides long-term motor and cognitive benefits in murine embolic stroke model (eMCAO). American Stroke Association– International Stroke Conference, San Diego, Calif., February 2014
Names in blue indicate faculty members or residents in the Georgia Regents University Neurosurgery or Neurology departments.
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Sazonova IY, Janes F, Waller JL, Brittain JE, Gigli GL, Giacomello R, Hess DC, Switzer JA A rapid clot lysis assay to predict response to IV rt-PA in stroke. American Stroke Association– International Stroke Conference, San Diego, Calif., February 2014 Hess DC Team of neurohospitalists, telestroke, and nurse stroke coordinator increases the use of intravenous alteplase in a community hospital H McCord Smith, St Mary’s Healthcare System, Athens, Ga. American Stroke Association– International Stroke Conference, San Diego, Calif., February 2014 Switzer JA Mortal kombat: The need for development and implementation of rigorous telestroke credentialing and training requirements. Symposium: Telestroke 2.0: Developing evidence-based measures of quality and outcomes for remote stroke management. American Stroke Association– International Stroke Conference, San Diego, Calif., February 2014
Switzer JA Role of endovascular interventions in acute stroke. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Switzer JA Carotid ultrasound for stroke prevention. Pool Society Weekend Radiology CME, Augusta, Ga., March 2014 Alleyne CH International collaborations in stroke research. Georgia Regents University Confucius Institute symposium, Kroc Center, Augusta, Ga., March 2014 Giller CA Surgery for Parkinson’s disease and essential tremor. Parkinson’s disease and essential tremor: Updates for best medications and surgeries, Augusta, Ga., March 2014 Rahimi SR Neurosurgical review: Closed head injuries. MCG 1st year class, Georgia Regents University, Augusta, Ga., March 2014
Switzer JA Anticoagulation for AFib. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014 Cerebral neovascularization in diabetes and stroke—we have shown that diabetes causes dysfunctional angiogenesis in cerebral vessels. Stroke stimulates reparative angiogenesis in the non-diabetic state. However, when stroke occurs in diabetes, survival signals are lost, leading to cerebral vascular regression. Our work has been appreciated due to its clinical and translational impact and was featured on the cover of the Journal of Cerebral Blood Flow and Hemodynamics.
Bruno A Is this patient having a TIA or something else? Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014 Bruno A Cervical carotid disease. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Alleyne CH Update on subarachnoid hemorrhage and intracranial aneurysms. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Choudhri HF Minimally invasive spine surgery: Is it really necessary? 15th Dubai Spine Conference/10th Pan Arab Spine Society, Dubai, April 2014
Bruno A Is this patient having a stroke or something else? Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Choudhri HF Surgical management of sacral fractures. 15th Dubai Spine Conference/10th Pan Arab Spine Society, Dubai, April 2014
Choudhri HF Strategies to reduce the need for revision spine surgery. 15th Dubai Spine Conference/10th Pan Arab Spine Society, Dubai, April 2014 Choudhri HF Lateral transpsoas approach (Cadaver lab instructor). Gulf University, Ajman, United Arab Emirates, April 2014
Nichols F When to suspect acute vertebrobasilar ischemia. Comprehensive Stroke Management Update, Hilton Head, S.C, April 2014 Nichols F Hypertension and cerebrovascular disease. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Choudhri HF Posterior C1-2 Instrumentation (Cadaver lab instructor). Gulf University, Ajman, United Arab Emirates, April 2014
Ramesh S Contemporary management of intracerebral hemorrhage. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Choudhri HF Occipital-cervical instrumentation (Cadaver lab instructor). Gulf University, Ajman, United Arab Emirates, April 2014
Ramesh S Avoiding acute stroke complications. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014
Switzer JA How can telestroke help? Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014 Vender JR Malignant cerebral edema. Comprehensive Stroke Management Update, Hilton Head, S.C., April 2014 Vender JR CNS malignancies. The 49th Annual Primary Care and Family Medicine Symposium, Augusta, Ga., April 2014 Vender JR Gamma Knife. The 49th Annual Primary Care and Family Medicine Symposium, Augusta, Ga., April 2014
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noon
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noon
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10 am
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Anatomy
noon
Case Conference
10 am
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noon
Case Conference
10 am
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Aug. 15 11 am noon
Case Conference
10 am
Oral Board Review
10 am
Resident Meeting
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Aug. 22 11 am
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National Medical Association August 2–6 Honolulu, Hawaii
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Society of NeuroInterventional Surgery July 28–31 Colorado Springs, Colo.
Neuro 101—Khoi Nguyen
noon June 13 11 am
Neurosurgical Society of America June 8–11, New Brunswick, Canada
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July 25 11 am
May 30 9 am–noon MILESTONE EVALUATIONS
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noon
noon
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Meeting Schedule
Radiology
June 20 11 am
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May–August 2014
Neurosurgery
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noon
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Neurology May 1 AAN Meeting: No Grand Rounds Dr. Michelle DeJesus May 8 (Senior Resident)
MABUHAY
May 15 Dr. Kapil Sethi (Dr. Lang)
Movement Disorders
May 22 Dr. Yong Park
Epilepsy
May 29 Dr. Ed Hartmann
Neuromuscular
Dr. Nirav Pavasia June 5 (Senior Resident)
Movement Disorder’s in Pregnancy
Dr. Tom Kurian June 12 (Senior Resident)
Re-emerging Infectious Diseases and Neurologic Complications
June 19
Dr. Nirav Shah (Senior Resident)
Neuro-Rheumatology and AAN Update 2014
June 26 Dr. Tom Swift (Resident)
Case Presentation
July 3 No Grand Rounds July 10 Kiawah Conference—No Grand Rounds July 17 Dr. J. Ned Pruitt
Education Update
July 24 Dr. Ed Hartmann
Neuromuscular
July 31 Dr. Askiel Bruno
Stroke
Aug. 7 Dr. Tom Swift
Case Presentation
Aug. 14 Dr. John Morgan
Movement Disorders
Aug. 21 Dr. Anthony Murro
Epilepsy
Aug. 28 Dr. Klepper Garcia
Neuro Critical Care
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