Neurosurgeon, Dr. Bradley Gross from the UPMC Neurological Institute discusses new advances in research and surgeries in treating stroke patients, as well as the signs and symptoms that indicate a stroke in patients.
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– [Narrator] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
– One of the top centers in the country for neurological care. Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso. And joining us right now is Dr. Bradley Gross. He is a neurosurgeon with the UPMC Neurological Institute. Doctor, thanks so much for joining us.
– Thank you for having me.
– So, doctor, you all see at the institute cases that are very common to some of the most complex.
– That’s correct. The UPMC Neurological Institute is comprised of both the Department of Neurological Surgery and the Department of Neurology. Each are comprised of highly specialized physicians that super-specialize in a very specific discipline, respectively, within neurology or neurosurgery. And quite specifically, having a neurological institute where neurology works hand-in-hand closely with neurological surgery allows us to provide optimal care for a variety of conditions. For example, patients with epilepsy can work with a neurologist and an exceptional neurosurgeon to manage it as needed, or germane to me, patients with issues with the vasculature, that is the arteries of the brain or the veins of the brain, can see a neurologist, a stroke neurologist, as well as a stroke-specialized neurosurgeon.
– And how important, then, it really is the front door. Someone comes in with symptoms and they really do go through a full spectrum before being diagnosed, correct?
– That’s absolutely correct. If they come emergently to the emergency department, their work-up is obviously extremely fast so that we can provide them with optimal, timely care. If they come to the outpatient department, we see them in the clinic, be it ourselves or with neurologists to provide them with the best possible solution to whatever problem we can help them with.
– And really, innovation and cutting-edge treatments and devices are always underway at the institute.
– As a result of the high volume that we have here at UPMC from the multiple hospitals that consult us or work with us in the UPMC network, we’re able to see a wide variety of cases. And as such, companies with new devices and so forth really like to partner with high-volume centers like UPMC so we can provide and use their cutting-edge technology.
– And so let’s talk: You mentioned that you focus on strokes. What typically happens in the body when someone has a stroke?
– So, there are two types of stroke: ischemic stroke or hemorrhagic stroke. Ischemic stroke specifically refers to the blockage of a blood vessel in the brain. As a result of that blockage, that part of the brain does not function properly. And as such, that part of the brain doesn’t work and the patient develops perhaps weakness on the other side of the body, or, most often on the left side of the brain, difficulty with production of speech. So that’s an ischemic stroke. Hemorrhagic stroke broadly refers to bleeding into the brain. Now that can present just like an ischemic stroke, where if someone bleeds into an area of the brain that controls a certain part of the body, they can present with weakness or with similar symptoms. The way that an emergency room physician and stroke neurologist differentiate that is that when a patient presents with these acute neurological symptoms, we simply get a CAT scan to discern whether there’s a blockage of the blood vessel, perhaps, or a bleed into the brain.
– And so who’s at risk for a stroke?
– Primary risk factors for stroke are poorly controlled blood pressure, poorly controlled cholesterol levels, in addition to smoking as well. In addition, patients with specific cardiac conditions like atrial fibrillation, particularly if they’re not on blood thinners, or patients with heart failure, or patients with family history or a hypercoagulable disorder, meaning they have a tendency to form blood clots, are generally at highest risk of having a stroke.
– Are there preventive measures someone can take to prevent a stroke?
– Absolutely. If one has high blood pressure, high cholesterol, or heart failure, obviously seeing your primary care physician and taking your medications and being compliant is obviously an important first step. Secondarily, very importantly, smoking cessation has innumerable benefits to the body, particularly in the realm of stroke and diseases of the brain.
– Doctor, what are the symptoms of a stroke?
– So for an ischemic stroke, that is when you have a blockage in the artery of the brain, symptoms can be relatively minor, such as just numbness or tingling on one side of the body, or more major, start involving weakness on one side of the face, weakness of the arm or leg, or specifically, difficulty producing or difficulty speaking. Those are the most common symptoms of ischemic stroke.
Hemorrhagic stroke, where there’s a bleed into the brain, can also manifest almost identically to an ischemic stroke: that is, with weakness, difficulty speaking. But in addition or alternatively, patients may simply have the worst headache of their life or a very severe headache.
– Can you touch on more and explain a little bit more about when you are involved as a neurosurgeon and the types of surgeries that you perform?
– I am both a neurosurgeon that performs craniotomies or traditional neurosurgery, but I’m also particularly specialized in interventional neuroradiology, or endovascular neurosurgery, which is where we minimally invasively through either entry site in the groin or in the wrist, enter into the blood vessels. We tunnel tubes all the way up into the brain to treat problems. So, for example, when someone has an ischemic stroke, where there’s a blockage of an artery in the brain, what we can do is we can actually go in through either the artery in the leg or in the wrist, and tunnel a tube all the way up to that blockage, and simply apply suction to remove that blockage. And specifically, in the treatment of cerebral aneurysms, there are tremendous advances. That is, initially decades ago, we were relegated to only treating patients by opening up their head and doing relatively invasive procedures that we still sometimes certainly need to do today. However, procedures are getting less and less invasive. That is one of the things that I traditionally did is put coils into aneurysms. That is, an aneurysm is a weak spot on the blood vessel, and we navigate a tube through to the artery in the leg or the wrist into the aneurysm, and we close it off with these little coil devices. Well, even that has a matter of fact evolved to the point where now we are simply putting these single, what we call intrasaccular flow diverters, these devices that on one single pass basically close off the aneurysm. And so it’s very exciting to be a part of a field that is advancing simply by the month or the year and providing better and better care and options for patients.
– And so much of the work also involves research and collaboration.
– UPMC is part of multiple studies, specifically in ischemic and hemorrhagic stroke. We have some single-center studies where we evaluate a variety of catheters and stroke techniques in order to assess what are the safest and most effective techniques for our patients. In addition, UPMC has a wonderful history of being involved in truly seminal stroke studies. Most recently, for example, the DAWN study, which was a multi-center study run by Dr. Jovin and Dr. Nogueira that has absolutely changed the way that we have treated stroke the past couple of years at UPMC and worldwide. Quite specifically, what this study demonstrated, in which UPMC was a substantial part, is that patients are not necessarily restricted to the time they were last seen normal when they’re having a stroke. That is, we used to treat patients only up to six or eight hours from the time they were last normal, in order to try to open up the vessel and improve their symptoms. However, this study showed that patients up to 24 hours from last seen normal that don’t have a lot of brain that has been affected by the stroke can undergo a procedure to open up the artery and can in fact, have tremendously better outcomes than patients that are not treated with that procedure.
– Can you talk about the recovery in terms of therapy and that sort of thing, and is it possible to reverse damage?
– Absolutely. So we, in a hearty subset of patients, for example, that prevent would say paralysis on one side of the body and a blockage of the artery in the brain, we see that as soon as we open up the artery on the table where we perform the procedure, they start to move the arm and/or the leg, or start to speak immediately, which is phenomenal. But nevertheless, we know that not all patients have that kind of a response. And with a comprehensive rehabilitation program that we have here, which is absolutely phenomenal, patients can also gradually improve and gradually regain function as well.
– And doctor, let’s talk about care and particularly stroke care and how COVID-19 has impacted that.
– That’s a very important question. We’ve been very lucky in Pittsburgh, where we have not had as many cases of COVID as say in New York and other cities in the United States. So these other cities have found, actually, some neurological implications of COVID that I think are extremely important. On the other hand, in Pittsburgh, the main thing that I am seeing, unfortunately, is that patients that have stroke-like symptoms seem to be taking longer to seek care, which is not unreasonable in the context of being concerned about the virus. However, unfortunately, this translates potentially into worse outcomes, as we know that the sooner we can treat patients that are having potential strokes, the better off they can generally be. And so what I would encourage patients that have symptoms like stroke, weakness on one side of the body or anything of concern, is to seek medical care as soon as possible.
– So, doctor, are you using video visits and telemedicine as well?
– That has been a wonderful and convenient change that we’ve seen for the past few months here at UPMC. Specifically, patients with elective problems — that is, problems that do not necessarily need to be managed emergently — I can often have video visits with them to discuss their problems, explain it to them. Perhaps some problems with the blood vessels only need to be managed with say, an aspirin or a blood thinner. And this provides a tremendous convenience that the patients certainly appreciate, and the physicians do as well because we can provide them with very timely and relaxed care, and provide them with reassurance and the comfort sometimes of their own home.
– So, doctor, as we close, what do you want to say to patients about why it’s important to get their health care back on track?
– I want to emphasize the fact that coming to UPMC and coming to the hospital is extremely safe. And that waiting too long for symptoms that could be potentially concerning, specifically the nervous system, the brain, is really not advisable. We have very safe measures here to take safe care of patients, and again, we don’t want to let things slip through the cracks to the point that we cannot fix them or make them better for our patients.
– Well, Dr. Bradley Gross, some great information. Thank you so much for spending some time with us today.
– My pleasure. Thank you.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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The UPMC Department of Neurosurgery is the largest academic neurosurgical provider in the United States. We perform more than 11,000 procedures each year. We treat conditions of the brain, skull base, spine, and nerves, including the most complex disorders. Whether your condition requires surgery or not, we strive to provide the most advanced, complete care possible. Our surgeons are developing new techniques and tools, including minimally invasive treatments. U.S. News & World Report ranks neurology and neurosurgery at UPMC Presbyterian Shadyside as among the best in the country. We also rank among the top neurosurgery departments in the U.S. for National Institutes of Health funding, a benchmark in research excellence.