Neuroscience Outlook Vol 12 Issue 2

A Triannual Publication of GRHealth

NEUROSCIENCE OUTLOOK News and Research from the Departments of Neurology and Neurosurgery

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VOL. 12 | ISSUE 2 NEUROSCIENCE OUTLOOK

FROM THE CHAIRMEN

DEAR READERS,

From left: Cargill H. Alleyne, Jr., MD Professor and Marshall Allen Distinguished Chair of Neurosurgery David C. Hess, MD Professor and Presidential Distinguished Chair of Neurology

Welcome! In this edition of Neuroscience Outlook we discuss exciting new data from five recent randomized clinical trials which have all shown significant benefit of mechanical thrombectomy in patients with occlusion of the intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA). Thus, there is now conclusive evidence that endovascular treatment with the newest generation of devices benefits these patients. Further work needs to be done to refine optimal selection of patients. Also in the clinical spotlight, we discuss minimally invasive approaches to the ventricles including endoscopic third ventriculostomy. These modern techniques have improved diagnosis and treatment of deep-seated ventricular and periventricular lesions.

In this issue, we outline the achievements of our faculty and residents and present newsworthy items from both the Neurology and Neurosurgery departments. Publications and presentations from the first four months of 2015 are also listed. Our donors remain an invaluable asset to both departments and much of our clinical, research, and educational endeavors are facilitated by their generosity.

We hope you continue to enjoy these periodic updates of our departments as we strive to maintain excellence in our tripartite mission. Please feel free to contact us with any questions or comments.

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IN THIS ISSUE VOL. 12 | ISSUE 2

faculty & staff update________________4

Neuroscience Outlook is produced triannually by the Medical

College of Georgia Departments of Neurology and Neuro-

Resident Update______________________4

surgery and the Georgia Regents University Division of Communications and Marketing. Please direct comments or

department news_____________________4

questions to marketing@gru.edu.

clinical spotlight: a paradigm shift in stroke treatment__________________5

Editor-in-Chief: Cargill H. Alleyne, Jr., MD

systems of stroke care_______________8

Illustration: Colby Polonsky, MS

clinical spotlight: minimally invasive approaches to the ventricles________10

Contributors: Jeffrey Switzer, DO, Scott Rahimi, MD, William Todd, MSN, FNP, David Hess, MD, S. Dion Macomson, MD, and Cargill H. Alleyne, Jr., MD

publications & presentations_________13 the clinical team_____________________14 Thank you, Donors___________________15

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FACULTY & STAFF UPDATE

NEUROSCIENCE OUTLOOK

Cargill H. Alleyne, Jr., MD (Department of Neurosurgery) was named a Castle Connolly Top Doctor for 2015.

Krishnan Dhandapani, PhD (Department of Neurosurgery) received the 2015 Distinguished Alumnus Award from the Graduate School at Georgia Regents University. He also served on the NIH Brain Injury and Neurovascular Pathologies Study Section in February and chaired the Brain 2 Study Section of the American Heart Association. In addition, he was the ad hoc scientific reviewer for the Scientific Research Support Fund (Amman, Jordan).

Ian Heger, MD (Department of Neurosurgery) passed the Maintenance of Certification examinations in March.

RESIDENT UPDATE

Synaptic Plasticity) in the Neurodegeneration Study Section in February. In March, he was also Session Chair of Contribution of Glia to Neuronal Networks in Vivo at the Gordon Research Conference on Glial Biology: Functional Interactions among Glia and Neurons.

John Morgan, MD, PhD (Department of Neurology) was inducted into the Gold Humanism Honor Society, an honor society exemplified by exemplary service, clinical excellence, integrity, and compassion.

Sangeetha SukumariRamesh, PhD (Department of Neurosurgery) first authored an article (Overexpression of Nrf2 attenuates carmustine-induced cytotoxicity in U87MG human glioma cells, BMC Cancer 15:118, 2015) which received the “Highly accessed” tag indicating that the manuscript is highly accessed in the journal of BMC cancer, relative to its age.

David C. Hess, MD (Department of Neurology) served as the Co-chair for the NINDS Clinical Trials SEP Study Section in Washington, D.C., in March. He was also a Castle Connolly Top Doctor and was appointed to the Writing Committee for new guidelines on Telestroke by the American Stroke Association.

Kapil Sethi, MD (Department of Neurology) was a Castle Connolly Top Doctor for 2015.

Jeffrey Switzer, DO (Department of Neurology) was appointed to the Writing Committee for new guidelines on Telestroke by the American Stroke Association.

Sergei Kirov, PhD (Department of Neurosurgery) was NIH Study Section Reviewer for Fellowships (Neurodevelopment,

June Yowtak, MD, passed the written Neurosurgery Board examinations in March.

Angela Viers, MD, passed the written Neurosurgery Board examinations in March.

NEWS from the DEPARTMENTS (January-April) n Cannabinol trials in epilepsy (Governor-directed) are enrolling well under Dr. Yong Park (Neurology) at GRU, which was the first site to begin enrollment. n A translational NIH/NINDS grant looking at LGR4/Agrin antibodies in patients with myasthenia gravis scored very well. This is a 25-site study led here at GRU by Drs. Lin Mei and Michael Rivner.

(Neurology) n The National Association of Epilepsy Centers (NAEC) recognized Georgia Regents Medical Center Comprehensive Epilepsy Center as a Level 4 Center. The center’s information and 2015 designation is posted on the NAEC website at naec-epilepsy.org.

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Jeffrey Switzer, DO, Scott Rahimi, MD, William Todd, MSN, FNP, David Hess, MD, and Cargill Alleyne, Jr., MD

CLINICAL SPOTLIGHT

a paradigm shift in stroke treatment In the past six months, acute stroke management has undergone its most significant shift in 20 years. Beginning in October 2014, five randomized clinical trials have been published demonstrating the superiority of endovascular thrombectomy combined with standard treatment (including intravenous tPA) when compared with standard treatment alone for patients with occlusion of the intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA). Large benefits were evident across the trials with a number needed to treat of 3.2 to 7.5 to achieve functional independence (mRS <2) for thrombectomy.

The five trials are Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN)1, Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE)2, Extending the Time for Thrombolysis in Emergency Neurological Deficits — Intra-Arterial (EXTEND-IA)3, Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME)4, and Randomized Trial of Revascularization with Solitaire FR Device versus Best Medical Therapy in the Treatment of Acute Stroke Due to an Anterior Circulation Large Vessel Occlusion Presenting within Eight Hours of Symptom Onset (REVASCAT)5.

Although, there are notable distinctions between these trials, some consistent themes are apparent. First, the efficacy of thrombectomy appears closely related to higher rates of reperfusion achieved with the latest generation of devices. The Solitaire FR stent retriever was used in 100% of cases in three trials and at least 80% of cases in the remaining two trials.

Across the trials, modified Thrombolysis in Cerebral Infarction Scale (TICI) Scores of 2b (>50% reperfusion of the previously ischemic territory) or 3 (complete

reperfusion) was achieved in 59 to 88% of subjects. This compares quite favorably with rates of 23 to 44% (depending on site of occlusion) in the IMS-3 trial6 published in 2013, which predominantly used earlier generations of thrombectomy devices or intra-arterial thrombolytics. Second, and not surprisingly, the importance of highly efficient processes of care appears crucial.

For example, in ESCAPE, the duration of CT to puncture (so called “picture to puncture”) was only 51 minutes and only 81 minutes from CT to reperfusion; these numbers compare favorably with 107 and 232 minutes respectively, in IMS-3. Similar to tPA, the efficacy of treatment likely diminishes with time from stroke onset.

Across the trials, some heterogeneity was apparent in terms of patient selection.

While all of the trials required confirmation of a large vessel occlusion of the intracranial ICA or proximal MCA with either CT or MR angiography, a variety of imaging selection tools were used to exclude futile cases and identify those most likely to benefit from thrombectomy. With the exception of MR CLEAN, all of the trials excluded patients with large infarct cores on baseline imaging. Three of the studies excluded patients with ASPECTS score less than 6 or 7, while EXTENDIA excluded infarct cores greater than 70 cc (defined as regions with cerebral 5

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blood flow reduced by 70% on perfusion imaging). The optimal imaging selection strategy requires validation in future trials.

The time window for thrombectomy requires further exploration as well. Three of the trials had a six-hour window from onset to groin puncture while two, ESCAPE and REVASCAT, had a 12- and eight-hour window, respectively. Across all the trials though, the median time to start of the procedure ranged from 185 to 269 minutes. Therefore, it remains unclear whether patients treated beyond six hours from time last known well (including “wake up” strokes) benefit from thrombectomy. Perfusion imaging tools, such as RAPID used in EXTEND-IA, may help to clarify the risks and benefits in this challenging population.

As occurred after the approval of IV tPA, systems of stroke care will once again need to reinvent themselves to make thrombectomy available to eligible patients regardless of geography. Joint Commission Comprehensive Stroke Center (CSC) accreditation identifies the select facilities with the infrastructure and personnel capable of performing thrombectomy and caring for these most severe stroke patients. Better prehospital assessment tools (screening for impaired consciousness, gaze deviation, and hemiplegia for example) are needed to help EMS providers identify stroke patients with large vessel occlusion that need to be transported directly to a CSC and which patients can be successfully managed at a Primary Stroke Center.

In Georgia, GRU is the only CSC outside the Atlanta area. We are currently working with local, regional, and statewide prehospital partners to expedite identification and transfer of thrombectomy candidates.

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case 1:

a paradigm shift in stroke treatment

A 41-year-old man was transferred to our institution from an outside hospital with a one-day history of worsening headaches, altered mental status, and weakness. On initial evaluation, he was nonambulatory due to extremity weakness. He also had ophthalmoplegia with upward and lateral gaze palsies. MRI of the brain showed multiple focal pontine infarcts. MRA of the brain was suspicious for irregularity and dilatation in the basilar artery. He was taken to the angiogra-

phy suite for a cerebral angiogram, which showed a fusiform dilatation in the basilar artery with an underlying dissection and no visualization of the posterior cerebral arteries. He underwent intracranial stent placement in the basilar artery.

At his six-month follow-up study, he had complete resolution of the dissection and normal flow throughout the posterior circulation. He has made an excellent recovery with his only remaining symptom including difficulty with balance.

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure legend Figure 1: MRI of the brain (DWI sequence) showing an acute infarct in the brainstem.

Figure 2: MRA of the brain showing irregularity in the basilar artery.

Figure 3: AP cerebral angiogram demonstrating dissection with pseudoaneurysm formation in the basilar artery. No opacification of the posterior cerebral arteries is seen.

Figure 4: Lateral cerebral angiogram showing dissection and pseudoaneurysm of the basilar artery. The basilar artery terminates into the superior cerebellar arteries with no visualization of the posterior cerebral arteries.

Figure 5: Angiogram showing stent wire prior to deployment past the level of dissection with improved flow into the posterior cerebral arteries.

Figure 6: Six months following basilar artery stent angiogram demonstrating normal filling and appearance of the posterior circulation.

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case 2:

a paradigm shift in stroke treatment

An 84-year-old woman was found with a left MCA syndrome in the morning while an inpatient at an outside hospital.

She was transferred to our institution with NIHSS 12 with last known normal exam five hours prior to transfer. Patient under-

Figure 1

went a cerebral angiogram with mechanical thrombectomy with use of a stent-retrieval device. Her exam improved to NIHSS of 2 immediately following the examination. She was discharged from the hospital with a normal neurologic exam.

Figure2

Figure 3

Figure legend Figures 1 & 2: CTA 3D reconstruction images showing occlusion of the mid M1 segment of the left middle cerebral artery.

Figure 3: Cerebral angiogram better demonstrating the M1 occlusion with no opacification of the distal MCA branches.

Figure 4: Cerebral angiogram following stent retrieval use for the M1 segment occlusion showing TICI 3 revascularization of the MCA vessels.

Figure 4

References: 1. Berkhemer OA, Fransen PSS, Beumer D, et al. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N Engl J Med 372:11-20, 2015.

2. Goyal M, Demchuk AM, Menon BK, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med 372:1019-30, 2015.

3. Campbell BCV, Mitchell PJ, Kleinig TJ, et al. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med 372:1009-18, 2015.

4. Saver JL, Goyal M, Bonafe A, et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N Engl J Med Apr 17, 2015 [DOI: 10.1056/ NEJMoa1415061].

5. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N Engl J Med Apr 17, 2015 [DOI: 10.1056/NEJMoa1503780].

6. Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368:893-903, 2013.

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CLINICAL SPOTLIGHT

S. Dion Macomson, MD

minimally invasive approaches to the ventricles History of ETV

1960s, technological advances related to the endoscope continued. Neuroendoscopy took a giant leap forward with the There is a wide spectrum of pathologies that can affect the ventricles of the invention of charge-coupled devices and brain. Treatment of these pathological entities can be especially challengfiber-optics7. These technologies were able ing due to the anatomical location of the ventricles. The ventricles are deep to provide the balance needed between within the brain and are in close proximity to vital structures. Direct apimage quality, illumination, and smaller proaches are possible but require extensive brain dissection and retraction. instruments. The endoscopic treatment of hydrocephalus saw a resurgence after He used a small cystoscope borrowed ventriculoperitoneal shunting proved not Fortunately minimally invasive techfrom a gynecologist at Johns Hopkins to be without its own complications. In niques to approach the ventricles have the modern era, technology has provided been developed that are safe and effective. Hospital to remove the choroid plexus 3 smaller scopes with designated instruThese techniques resulted from the fusion in two cases . Dandy was also the first to of a variety of ideas from different surgical describe the ideal location for the opening ments, high definition quality imaging, of a third ventriculostomy5. Dandy’s early and frameless stereotactic image guidance. specialties and have evolved over time. attempts with the endoscope were met Endoscopic procedures are not limited The first endoscopic instruments date with frustration due to limited visualizato the treatment of hydrocephalus but back to the early 1800s and are credited tion and inability to precisely manipulate include removal of colloid cysts, biopsy to Antonin Desormeaux1. They consisted tissue through the scope, and thus he and excision of third and lateral ventricuof cylindrical devices with reflective mirreverted to open procedures2. lar tumors, and treatment of infectious rors illuminated by kerosene lamps to The confluence of third ventriculosprocesses such as neurocysticercosis. inspect body cavities (figure 1). In 1867 Often two procedures can be performed Julius Bruck, a dentist in Breslau, contrib- tomy with ventriculoscopy is credited under one general anesthetic. uted a major advancePineal region tumors provide ment in scope technolFigure 1 the perfect opportunity to obogy with the integration tain tissue minimally invasively of an internal light 1 for diagnosis and to relieve source . Maximilian Niobstructive hydrocephalus in tze, a German urologist, the same setting using the refined the internal light endoscope. source and added lenses 9

The history of neurofor magnification . It endoscopy is a testament to wasn’t until 1910 that the importance of collaborathe devices were used tion and the spirit of innovafor neurosurgical proto William Mixter.

In 1923, he used a tion. What started over 200 years ago cedures. Viktor Lespinasse pioneered the urethroscope to perform the first truly as a crude means of visualizing areas of field of neuroendoscopy in 1910 when he the body that were previously inaccesused a urethroscope to perform a fulgura- minimally invasive endoscopic third ventriculostomy in a 9-year-old girl with sible without large surgical openings has tion of the choroid plexus in two infants 4 .

With the obstructive hydrocephalus 8 transformed into a highly refined and with hydrocephalus . However, Walter introduction of the valved ventriculoperitechnically sophisticated subspecialty of Dandy is considered the father of neurotoneal shunt in the 1950s for the treatneurosurgery. Thanks to the efforts of endoscopy to most neurosurgeons. In the ment of hydrocephalus, endoscopic third several individuals over a broad spectrum 1920s, he coined the term “ventriculosventriculostomy was almost completely of specialties, neuroendoscopic techniques copy” and described the anatomy of the abandoned6. Although utilization of the have improved the lives of many patients. ventricles as observed through a scope. procedure ebbed during the 1950s and

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case 1:

minimally invasive approaches to the ventricles

A 20-year-old man presented to the emergency room with a two-week history of headache, diplopia, nausea, and vomiting. An MRI scan was performed and demonstrated a pineal region mass causing obstructive hydrocephalus (figure 2). The differential diagnosis included germinoma, pineocytoma, pineoblastoma, lymphoma, and meningioma. Serum markers were obtained and were negative for betahCG and alpha fetoprotein. MR imaging of the entire spine showed no evidence of drop metastasis. Tissue diagnosis was considered essential to guide accurate therapy. The decision was made to perform an endoscopic biopsy and endoscopic third ventriculostomy.

Both procedures were performed through the same burr hole. The opening for the ventriculostomy is the area of the tuber cinereum that is halfway between the mammillary bodies

Figure 2

and the infundibular recess. The infundibular recess has a characteristic red tint to the tissue.

Figure 3 shows an intraoperatitve view of the third ventriculostomy. The endoscope was then guided posteriorly until the tumor was visible (figure 4). Samples were taken from the tumor and sent to pathology. The diagnosis of germinoma was made on the frozen section and confirmed on the permanent specimens.

Immediately following the procedure, the patient had significant relief of his headache and diplopia. Figure 5 is the post-operative MRI demonstrating a decrease in the size of the lateral ventricles. The patient was treated with radiation resulting in complete resolution of the tumor. MR imaging one year later demonstrated no evidence of tumor recurrence and no hydrocephalus (figure 6).

Figure 3

Figure 1: Antonin Jean Desormeaux and early endoscope Figure 2: A pineal region tumor with obstructive hydrocephalus Figure 3: Opening created in the floor of the third ventricle Figure 4: Intraoperative view of tumor Figure 5: MRI demonstrates decrease in the size of the lateral ventricles Figure 6: MRI one year after treatment

Figure 4

Figure 5

Figure 6 11

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case 2:

minimally invasive approaches to the ventricles

A previously healthy 31-year-old Hispanic man developed sudden onset of headache, confusion, and lethargy. He was initially seen in an outside hospital, and a CT was obtained showing an intraventricular cyst with obstructive hydrocephalus (figure 7). He was transferred to GRU, and bilateral external ventricular drains were placed to emergently treat the hydrocephalus (figure 8). An MRI was obtained to better evaluate the intraventricular lesion (figure 9). Labs were significant for elevated eosinophils. Based on the imaging

results and laboratory findings, a preliminary diagnosis of neurocysticercosis was made. He was started on albendazole, and the decision was made to remove the cyst endoscopically to treat the hydrocephalus and to remove the parasite.

The cyst was removed using the endoscope through a right frontal burr-hole. Figures 10 and 11 show the removal of the cyst on CT and MRI scans. The pathology was consistent with neurocysticercosis. The patient did not require a shunt.

Figure legend Figure 7: CT scan showing hydrocephalus and intraventricular cyst Figure 8: Bilateral EVD placement Figure 9: MRI showing intraventricular cyst Figure 10: CT scan post cyst removal Figure 11: MRI post cyst removal

Figure 7

Figure 8 References: 1. Abbott R: History of neuroendoscopy. Neurosurg Clin N Am 15:1–7, 2004.

2. Dandy WE: Cerebral ventriculoscopy. Bull Johns Hopkins Hosp 33:189, 1922.

3. Dandy WE: Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg 70: 569&#150;579, 1918.

4. Mixter WJ: Ventriculoscopy and puncture of the floor of the third ventricle. Boston Med Surg J 188:277–278, 1923.

5. Hsu W, Li KW, Bookland M, Jallo GI: Keyhole to the brain: Walter Dandy and neuroendoscopy.

Historical vignette. J Neurosurg Pediatr 3:439–442, 2009.

6. Nulsen FE, Spitz EB: Treatment of hydrocephalus by direct shunt from ventricle to jugular vein.

Surg Forum 2:399–403, 1951.

7. Boyle WS, Smith GE: Theinceptionofchargecoupleddevices. Electron Devices 23:661–663, 1976.

8. Davis L: Neurological Surgery. Philadelphia: Lea & Febiger; 1936.

9. Schultheiss D, Truss M, Jonas U: History of direct vision internal urethrotomy. Urology 52:729–734, 1998.

Figure 9

Figure 10

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Figure 11

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PUBLICATIONS & PRESENTATIONS

Members of the GRU Neurology and Neurosurgery departments are shown in bold

(January-April 2015) Presentations:

Bruno A: Standard IV tPA therapy in acute ischemic stroke – Black, white, & gray. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Alleyne CH: Contemporary African American academic surgeons.

History of the Health Sciences Lecture Series. Georgia Regents University, Jan 2015.

Bruno A: Is this patient having a stroke or something else? Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Kirov SA, Steffensen AB, Sword J, Croom D, MacAulay N: Activation of neuronal cotransporters as possible molecular mechanism of spreading depolarization-induced dendritic beading. The 48th Annual Winter Conference on Brain Research, Big Sky, MT, Jan 2015 (Poster).

Bruno A: Diagnosing and managing transient ischemic attacks. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Alleyne CH: Neurosurgery Management 4950 lecture, Hull College of Business, Georgia Regents University, Feb 2015.

Vaibhav K, Baban B, Wang P, Khan MB, Pandya C, Ahmed H, Chaudhary A, Ergul A, Heger I, Hess DC, Dhandapani KM, Hoda MN: Remote ischemic conditioning (RIC) attenuates post-TBI ischemic injury and improves behavioral outcomes. 2015 International Stroke Conference, Nashville, TN, Feb 2015

Hess DC: Emerging treatments for acute ischemic stroke: Breaking the logjam. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Hess DC: Telestroke – How useful can it be? Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Hess DC: Intracranial atherosclerosis - the most common cause of stroke in the world - How do we manage? Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Vaibhav K, Khan MB, Baban B, Ahmed H, Wang P, Chaudhary A, Fagan SC, Hess DC, Hoda MN, Dhandapani KM: Repeated remote ischemic conditioning (RIC) after intracerebral hemorrhage regulates macrophage polarization and CD36 expression to promote hematoma resolution. 2015 International Stroke Conference, Nashville, TN, Feb 2015.

Nichols F: Acute stroke complications. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Hewett SJ, Dhandapani KM, Gong Y, Shi J, Hewett JA: Regulation of constitutive neuronal cyclooxygenase-2 expression. 2015 American Society for Neurochemistry Annual Meeting, Atlanta, GA, Mar 2015.

Nichols F: What works in stroke prevention? Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Nichols F: Extracranial carotid disease - Stent, endarterectomy, or only medical management? Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Rahimi SY: Traumatic brain injury. Medi 5166 course instructor for M1 medical students, Georgia Regents University, Mar 2015.

Switzer JA: Update on management of acute intracerebral hemorrhage. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Woodall MN: Neuro 101: Management of traumatic brain injury.

Georgia Regents University Department of Neurosurgery Grand Rounds, Mar 2015.

Switzer JA: Endovascular therapies in acute ischemic stroke - Implications of latest findings. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Alleyne CH: What’s new about cerebral vascular malformations.

Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Switzer JA: How to choose an oral anticoagulant in non-valvular AFib. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Vender JR: Malignant cerebral edema in acute ischemic stroke. Comprehensive Stroke Management Update, Hilton Head, SC, Apr 2015.

Publications: Sukumari-Ramesh S, Alleyne Jr CH, Vender JR, Dhandapani KM: Overexpression of Nrf2 attenuates carmustine-induced cytotoxicity in U87MG human glioma cells. BMC Cancer 15:118, 2015 [DOI 10.1186/s12885-015-1134-z].

Switzer JA, Singh R, Mathiassen L, Waller JL, Adams RJ, Hess DC: Telestroke: Variations in intravenous thrombolysis by spoke hospitals.

JSCVD 24:739-44, 2015.

Giller CA, Jenkins P: Some technical nuances for deep brain stimulator implantation. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 2:29-39, 2015.

Khan MB, Hoda MN, Vaibhav K, Giri S, Waller JL, Ergul A, Dhandapani KM, Fagan SC, Hess DC: Remote ischemic postconditioning: harnessing endogenous protection in a murine model of vascular cognitive impairment. Transl Stroke Res 6: 69-77, 2015.

Cheyuo C, Woodall MN, Floyd DT, Santiago JA: American Journal of Neuroradiology Case of the Month: Hurst Disease. American Journal of Neuroradiology. Feb 2015.

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The clinical TEAM

ALS CLINIC Michael H. Rivner, MD EPILEPSY CENTER Cole A. Giller, MD, PhD Debra Moore-Hill, MD Anthony M. Murro, MD Yong Park, MD Gregory Lee, PhD GAMMA KNIFE CENTER Cargill H. Alleyne, Jr., MD Cole A. Giller, MD, PhD John R. Vender, MD MEMORY DISORDERS John C. Morgan, MD, PhD MOVEMENT DISORDERS Cole A. Giller, MD, PhD Julie A. Kurek, MD John C. Morgan, MD, PhD Kapil D. Sethi, MD MULTIPLE SCLEROSIS CENTER Suzanne H. Smith, MD

To make an appointment for your patient, please call 706-721-4581.

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NEUROLOGISTS Askiel Bruno, MD James Carroll, MD K. Alfredo Garcia, MD J. Edward Hartmann, MD David C. Hess, MD Julie A. Kurek, MD Gregory Lee, PhD Debra Moore-Hill, MD John C. Morgan, MD, PhD Anthony M. Murro, MD Fenwick T. Nichols III, MD Yong Park, MD J. Ned Pruitt II, MD Subhashini Ramesh, MD Michael H. Rivner, MD Elizabeth Sekul, MD Kapil D. Sethi, MD Suzanne H. Smith, MD Thomas Swift, MD Jeffrey A. Switzer, DO NEUROMUSCULAR DISEASES J. Edward Hartmann, MD J. Ned Pruitt II, MD Michael H. Rivner, MD NEUROSURGEONS Cargill H. Alleyne, Jr., MD Haroon F. Choudhri, MD J. Dan Dillon, MD Cole A. Giller, MD, PhD Ian Heger, MD S. Dion Macomson, MD Scott Rahimi, MD John Tuttle, MD John R. Vender, MD

THANK YOU,

NEURO CRITICAL CARE K. Alfredo Garcia, MD Subhashini Ramesh, MD

Neuroscience Donors!

PEDIATRIC NEUROSCIENCES James Carroll, MD Morris Cohen, EdD Ian Heger, MD Yong Park, MD Elizabeth Sekul, MD

Cargill H. Alleyne

JANUARY-MARCH 2015

SKULL BASE TUMOR CENTER Cargill H. Alleyne, Jr., MD John R. Vender, MD

ALS Association

Eileen V. Brandon

Haroon F. Choudhri

Columbia University Ernest C. Fokes Julie S. Kelley

Vicky M. Medlock Wes Richardson

Elizabeth A. Sekul

SLEEP MEDICINE Anthony M. Murro, MD Yong Park, MD

Kapil D. Sethi Eric Steckler

Margaret J. Taylor John R. Vender

SPINE CENTER Cargill H. Alleyne, Jr., MD Haroon F. Choudhri, MD Ian Heger, MD S. Dion Macomson, MD Scott Rahimi, MD John Tuttle, MD John R. Vender, MD STROKE AND CEREBROVASCULAR CENTER Cargill H. Alleyne, Jr., MD Askiel Bruno, MD David C. Hess, MD Fenwick T. Nichols III, MD Scott Rahimi, MD Jeffrey A. Switzer, DO

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Neuroscience Conference Schedule May 15 10 a.m. Anatomy 11 a.m. Oral board review 12 a.m. Case Conference May 22 10 a.m. Radiology 11 a.m. Functional (Dr. Giller) 12 p.m. Case Conference May 29 9 a.m. Pathology (Dr. Sharma) 10 a.m. Resident Meeting 11 a.m. Journal Club 12 p.m. M&M

Jun 5 10 a.m. Milestones 11 a.m. Milestones 12 p.m. Milestones Jun 12 10 a.m. Oral Board Review 11 p.m. Neuro 101 (Dr. Todnem) 12 p.m. Case Conference June 19 10 a.m. Radiology 11 a.m. Functional (Dr. Giller) 12 p.m. Case Conference

MEETINGS

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June 26 9 a.m. Pathology (Dr. Sharma) 10 a.m. Resident Meeting 11 a.m. Journal Club 12 p.m. M&M July 3 Holiday July 10 10 a.m. Oral Board Review 11 a.m. Neuro 101 (Dr. Viers) 12 p.m. Case Conference July 17 10 a.m. Radiology 11 a.m. Functional (Dr. Giller) 12 p.m. Case Conference July 24 9 a.m. Pathology (Dr. Sharma) 10 a.m. Resident Meeting 11 a.m. Journal Club 12 p.m. M&M July 31 No Conference August 7 10 a.m. Anatomy 11 a.m. Business (Dr. Giller) 12 p.m. Case Conference

August 14 10 a.m. Oral Board Review 11 a.m. Neuro 101 (Dr. Yowtak) 12 p.m. Case Conference August 21 10 a.m. Radiology 11 a.m. Functional (Dr. Giller) 12 p.m. Case Conference

August 28 9 am Pathology 10 am Resident Meeting 11 am Journal Club 12 pm M&M

Neurology Conference Schedule May 7: Case Presentation (Dr. Swift) May 14: On Pyotr Alexeyevich Romanov & Kozhevnikov

(Dr. Sethi) May 21: Resident (Dr. Edry) May 28: Stroke (Dr. Hess) June 4: Resident (Dr. Afzal) June 11: MDA (Dr. Wicklund) June 18: Resident (Dr. Davis) June 25: Resident (Dr. Villarreal) July 2: No Grand Rounds July 9: Kiawah Conference – No Grand Rounds July 16: Education Update (Dr. Pruitt) July 23: Case Presentation (Dr. Swift) July 30: Epilepsy (Dr. Park) August 6: Stroke (Dr. Bruno) August 13: Movement Disorders (Dr. Kurek) August 20: Case Presentation (Dr. Swift) August 27: Neuromuscular (Dr. Hartmann)

May 2-6: American Association of Neurological Surgeons, Washington, D.C. May 22–24: Georgia Neurosurgical Society, Sea Island, Ga. June 6-9: Society of Neurological Surgeons, Miami, Fl. July 27–30: Society of Neuro-Interventional Surgery, San Francisco, CA August 1-5: National Medical Association Detroit, MI

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