2018-11-14 / Front Page

Mt. Sinai Doctors Come To Riccardo's

By Thomas Cogan

Hazem Shoirah, MD (Doctor Z.) explains the functions of the lobes of the brain to his Astoria Civic Association audience.
    Photo DA LuhmannHazem Shoirah, MD (Doctor Z.) explains the functions of the lobes of the brain to his Astoria Civic Association audience. Photo DA LuhmannThe November meeting of the Astoria Civic Association was held at Riccardo’s by the Bay the night of Election Day.  Two doctors representing Mount Sinai of Queens talked about strokes and how MSQ is preparing to treat them in a new center that looks to become one of the world’s leading surgical facilities for the relief of this dreaded affliction’s complications.  

Drs. Reade De Leacey and Hazem M. Shoirah (Doctor Z.) had an audio/visual show about how a brain is stricken by either a cutoff of blood to any part of it or, in contrast, an excess of blood escaping from it.  

There was a question period from the audience afterward. Dr. De Leacey, assistant professor of neurology and radiology at Klingenstein Clinical Center in Mt. Sinai’s medical complex at 1450 Madison Ave. in Manhattan, began by describing two kinds of stroke, ischemic and hemorrhage.  The first occurs when the brain is starved for blood because the flow has been interrupted; the second when the flow of blood breaks its boundaries and massive bleeding results.

The effort to restore or control the flow of blood is critical.  “Time is brain” is the saying because the patient is facing either death or serious debilitation from the destruction of brain cells.  In the Manhattan facilities, he said, the route from the emergency entrance to the operating room is long and filled with obstacles.  It takes such a long time that the ideal time from one end to the other is one hour.  

He showed the plan for the MSQ stroke center, which is to be one 4,000 square foot room which should decrease transportation time radically.  (He said the brain ages 3.6 years with each lost minute.)  In the new center, the ideal time is projected to drop from 60 to an astounding 15 minutes.  The new center is expected to be operational by mid-2019.

Several stroke operations, from places near and far, were reviewed, beginning with the one performed on a Tennessee woman, 32 years old and a mother, but a heavy smoker too.   
She had facial paralysis and had lost her power of speech.  Dr. De Leacey showed a picture of her brain and where her blood flow, traced with dye, had been blocked.  

A catheter was run between her groin and her brain and after a few minutes spent restoring the blood flow her speech and facial mobility were restored, and additionally she had no memory of being afflicted.  It was the desired ending, because the stroke was relieved with minimal physical damage.  

Dr. Shoirah, among other duties the director of thrombectomy services in Queens, began his talk by showing a map of blockage in the carotid artery and then showed one side of a brain as he explained the activities of the frontal, parietal, temporal and occipital lobes. 

Thrombectomy means surgical removal of blood clots and Dr. Z. said they were not performed on anyone in Queens until last year.

That first patient, in October of 2017, was a 93-year-old woman felled at home.  Her stroke symptoms were “really bad,” Dr. Z. said.  A CAT scan showed blockage in her brain, but the clot was removed by thrombectomy and her post-operative condition went from serious to nearly trouble-free in less than a week.  An 89-year-old woman’s stroke was relieved when a clot nearly a centimeter long was removed from her brain, the doctor said.  Her health was significantly restored.  Since that 93-year-old was operated on a little more than a year ago, 14 others have undergone stroke operations.

Thing weren’t so fortunate for a 32-year-old woman, since her case involved heavy drug use.  She had a stroke while under the influence of cocaine, so much so that it transpired she didn’t even know she was stricken.  Worse, she was sent to a hospital that couldn’t treat her and had to send her to MSQ, with much time lost.  Though the clot causing the stroke was removed, her condition had so deteriorated that she was invalided for life.

A question about stroke and aspirin was asked by ACA’s director, Peter Vallone.  Dr. De Leacey said that only a CAT scan can determine what type of stroke it is, ischemic or hemorrhage, so neither aspirin nor anything else should be given to a victim.  Aspirin, a blood thinner, would be catastrophic for a hemorrhage, he said.

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