WHAT’S INSIDE If you are interested in volunteering or donating to the efforts of Dr. Green and his team please visithttp://umglobalinstitute.com

Aaron Cohn, Neurology ACNP-BC, MSN, with his Haitian translators in the UM/Project Medishare tent hospital.

An Update from Haiti Funding, Progress and Patient CareThe University of MIAMI has received more

than $7-million in donations for its relief efforts in Haiti through the University’s Global Institute/Project Medishare. The University was also recently awarded a $500,000 grant from the Clinton Bush Haiti Fund to support the ongoing medical relief efforts for earthquake survivors. More than 100 of the University’s doctors, nurses, and other staff members have traveled to Haiti since the earthquake to volunteer in the University’s 240-bed tent-hospital.

The rapid and extensive response of the University was made possible by the 15 year pre-existing relationship with Haiti through the contribution of Project Medishare, a program co-founded by Barth Green, M.D., professor and chair of the department of neurological surgery. Miller School of Medicine physicians were the first to arrive in Haiti, less than 24 hours after the earthquake. The team, led by Dr. Green, hit the ground running, treating patients and conducting life-saving procedures with basic instruments and alcohol in make-shift ORs.

This effective system has found representatives from the departments of neurological surgery and neurology working side-by-side, as one unified team diagnosing and treating patients with care, speed and precision.

“Many patients who are seeking care travel five to six hours or more over the roughest of roads to get to UM/Medishare Hospital. One patient, with multiple lumbar fractures and partial lower extremity paralysis, traveled five hours on a collapsed beach lounger to reach our facility,” said Aaron Cohn, Neurology ARNP, who spent a week in Haiti.

Neurology nurses, like Aaron Cohn and Ginna Gonzalez, Director of Nursing, have been diagnosing patients upon arrival and then consulting with members of the neurosurgical team who are rotating into the tent-hospital. These include Dr. Barth Green, Dr. Michael Wang, Dr. Allan Levi and Dr. John Ragheb. Specializing in areas such as spinal cord injury, spinal reconstruction, spinal surgery trauma and pediatric neurosurgery, these doctors have completed up to 15-16 cases in one weekend.

In the tent-hospital, before surgery is considered, patients are first diagnosed based upon their medical history (via a translator), and a physical and neurological exam focusing on weakness, deep tendon reflexes, decreased sensation and decreased movement. Assessments are also conducted for anterior, central or posterior spinal cord syndrome. There is only one x-ray machine to identify injury sites with fracture, disc herniation, secondary to subluxation of the inervertebral joint, narrowing of joint space and inappropriate alignment.

Procedures have included adult and pediatric traumatic amputations, maxillofacial surgery, closing of head injuries and treatment of pneumothorax. Patient trauma conditions are ranging from strokes, MI and crush injuries to gunshot and motor vehicle trauma. The UM/Medishare tent hospital is currently considered the Trauma 1 center for Port au Prince and the surrounding area and is averaging several hundred patients a day and running at maximum capacity.

This mounting necessity for a greater care capacity has accelerated the vision of Dr. Barth Green to create a full time critical care facility in Haiti. “One quarter of a million deaths and an equal number of injuries, many of which are catastrophic, The University of Miami and the Project Medishare team has been privileged to have the opportunity to take a leadership role in the resuscitation but the commitment now is for the next 15 years, not just the short-term.”

Despite a focus on the future, there is still a considerable amount to be done on the ground

now. Volunteers are committed to supply the hospital with necessary personnel for months but standard procedures like the basic patient assessment continue to be a challenge without all of the modern conveniences like CT, CT-angio, MRI, PET, etc. n

“Few groups have been able to deploy an effective system, and we were the first to be able to do so because Barth

Green and the Global Institute team at UM have such a deep knowledge of the region and its people,” said Miller School

Dean Pascal J. Goldschmidt, M.D.

Pg. 2 - Message from the Chairs of Neurology and Neurological Surgery, Clinical Trials Pg. 3 - Third Annual Symposium - Evelyn McKnight Donor Wall Dedication Ceremony, Haiti : A Vital Head Trauma DiagnosisPg. 4 - In The News, What’s Next, Resident Spotlight - Dr. Jose Gutierrez – PGY-3

NeuroFocus is produced by the Departments of Neurological Surgery and Neurology at the University

of Miami’s Miller School of Medicine in affiliation with Jackson Health System.

Dr. Barth A. Green and Dr. Allan D. Levi (left), care for a patient in Haiti days after the earthquake.

NeuroFocusA physician’s newsletter from the Departments of Neurology and Neurological Surgery at The University of Miami

SPRING 2010

Barth A. Green, M.D., F.A.C.S. Professor and Chairman of Neurological Surgery

Roberto Heros , M.D., F.A.C.S.Professor and Co-Chairman of Neurological Surgery

Ralph L. Sacco, M.S., M.D., F.A.A.N, F.A.H.A.Professor and Chairman ofNeurology

Dear Colleagues,The first months of 2010 have been challenging, yet filled with a sense of gratitude and purpose.

The earthquake in Haiti had a tremendous impact on the University of Miami (UM) and the Jackson Health System (JMH). We were the first medical personnel on the ground and in the weeks since the earthquake the University of Miami has provided urgent medical care to thousands of Haiti’s citizens. We have built a hospital that is staffed by hundreds of volunteers, including physicians, nurses and other administrative staff from University of Miami and Jackson serving several hundred patients per day. We will continue to support the Haitian people during this crisis while partnering to increase the overall quality of the country’s healthcare system.

In spite of the urgent demands of the natural disaster in Haiti, excellent research, educational and clinical work has continued at the UM Miller School of Medicine campus. The Evelyn F. McKnight Center for Age Related Memory Loss celebrated the completion of its second year at UM with an annual symposium and donor wall dedication. Our residents and fellows continue to make excellent contributions in their respective fields with notable publications and presentations at national conferences, and our progressive research programs have received federal and state stimulus package funds. The clinical programs at the UM and JMH are filled to capacity with patients seeking our high quality services.

The catastrophe in Haiti has reminded us of how much we appreciate our colleagues and partners, including the University of Miami’s Global Institute for Community Health and Development, and Project Medishare. We consider ourselves very fortunate to have the means and expertise to be able to serve others and we continue to strive toward building a legacy of service in our local and global community. We hope you enjoy this issue of NeuroFocus and we anticipate sharing more important news and information with you in our upcoming summer issue.

Neurology Epidemiologic Study of Stroke Outcome in Three Ethnic Groups The Northern Manhattan Study (NOMAS)Stroke is the 3rd leading cause of death and disability in the developed world and one of the

most important health problems in the US. With the rapidly increasing aging population (the

most frequently affected group) the problem of stroke is projected to exacerbate in decades to

come. The Northern Manhattan Study (NOMAS) is the first study of its kind to investigate the

genetics and epidemiology of stroke and stroke risk factors among three ethnic groups: Whites,

Blacks, and Caribbean Hispanics. In collaboration with Columbia University and the University

of Miami’s Hussmann Institute for Human Genomics, the 18-year-old study aims to identify

genetic and epidemiological factors related to stroke mechanisms that would help formulate

novel treatment and preventive strategies. The study was refunded through a NINDS Javits

Award with a collaboration between the University of Miami and Columbia University. The

study is closed to new enrollment, but the more than 3200 participants enrolled in the study

continue to provide a robust database that continues to be mined with the hope of identifying

ways to ameliorate and eventually prevent stroke and its consequences. The PI of the Study

is Ralph Sacco, MD, Olemberg Family Chair in Neurological Disorders and Chairman of the

Department of Neurology at the University of Miami’s Miller School of Medicine.

Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial StenosisSAMMPRISIntracranial atherosclerotic disease, or narrowing of the intracranial vessels, is a common cause

of stroke. It is an aggressive condition with a high rate of recurrence. This multicenter NIH-

sponsored study is evaluating whether aggressive medical therapy plus stenting of the intracranial

vessel is superior to aggressive medical therapy alone. Patients with intracranial disease of

70-99% confirmed by angiography within 30 days of stroke or transient ischemic attack are

eligible to participate. Eligible patients will be randomized to stenting plus medical treatment

or medical treatment alone. Aggressive medical treatment includes the combination of aspirin

and clopidogrel for 3 months followed by aspirin alone, intense lipid management to a LDL<70,

other vascular risk factor control and enrollment in a diet, exercise and habit modification

program supported by InterxVent. The Co-PI’s of the Study are Jose Romano, MD, Associate

Professor of Clinical Neurology, Chief of the Stroke Division and Dileep Yavagal, MD, Assistant

Professor of Clinical Neurology, Director of Interventional Neurology and Co-Director of

Endovascular Neurosurgery at the University of Miami’s Miller School of Medicine.

Secondary Prevention of Small Subcortical Strokes SPS3Small subcortical strokes, or lacunar strokes, account for up to 1 in 4 strokes and may affect

Hispanics and African Americans more commonly. Despite their importance, little is known

about the optimal way to prevent them. This multicenter NIH-sponsored study is evaluating

two interventions: the first is to determine whether the combination of aspirin plus clopidogrel

is superior to aspirin alone; the second is to evaluate if very aggressive blood pressure control is

superior to usual blood pressure management. Patients with a small subcortical stroke confirmed

by MRI within 6 months of the event are eligible to participate. In addition to recurrent stroke,

cognitive decline will also be evaluated by neuropsychological testing. The PI of the Study is Jose

Romano, MD, Associate Professor of Clinical Neurology and Chief of the Stroke Division at the

University of Miami’s Miller School of Medicine

Neurological SurgerySpreading depolarizations in the human brain COSBIDMulti-national and multi-center cooperative DoD funded study examining spreading

depolarizations in the human brain. COSBID (Cooperative Study on Brain Injury

Depolarisations) is designed to detect abnormal electric activity that follows when there is

brain damage. During this time of spreading depolarization the hypothesis is that the brain is

harmed severely, causing secondary brain damage. The study has enrolled a group of hospitals in

Europe and 6 hospitals in the US to measure the brain wave activity of patients that have had a

craniotomy as a result of traumatic brain injury. The University of Miami (UM) has currently

enrolled 8 into the trial. UM has found that one way to block these events from happening

is to cool the patient. All data is currently being collected and processed at the University of

Cincinnati.

Bypass surgery for complex aneurysms ELANASuturing vessels together in the depth of the brain in order to cure complex aneurysms that are

not amenable to traditional techniques (clipping or coiling), may have become easier and safer

with the introduction of Laser technology. The ELANA (Excimer Laser Assisted Non-occlusive

Anastomosis) technique eliminates the need to temporarily arrest blood flow in the brain

circulation during the suturing phase of surgery. The Neurosurgery Department at the University

of Miami is one of only five US Centers involved in a prospective human study investigating

the merits of this technique. The goal is to recruit 50 appropriately selected patients with

complex aneurysms to undergo the ELANA procedure. Several hundred patients have already

been successfully treated in Europe. FDA approval in the US is dependent on the results of our

study. Referral of complex aneurysms is welcome. Contact Dr Jacques Morcos, Professor of

Neurosurgery, at jmorcos@med.miami.edu. n

Clinical Trials

For more information on Neurology clinical trials please call 1-877-977-7724

For more information on Neurological Surgery Clinical trials please call 1-800-996-3783

Greetings From the Chairs of Neurology and Neurological Surgery

Coralie Mevs with her mother, Dr. Marguerite Mevs and Dr. Barth A. Green, after surviving the earthquake in Haiti.

Dr. Barth Green and his team have been focused on improving

healthcare in poverty-stricken Haiti through Project Medishare since 1994, but they have also established deep relationships with the Haitian people as a result of their efforts. Dr. Marguerite Mevs, a local pediatrician, and her family have been involved in assisting Dr. Barth Green for years. The Mevs family recently hosted a fundraising event for Dr. Green and his team in Port-au-Prince in December 2009. “Dr. Green is like part of our family when he comes to Port-au-Prince, my brother throws him a dinner and he has even stayed at my sister’s house,” said Dr. Mevs.

The friendship established between the Mevs family and Dr. Green became a life saving connection during the 7.0 earthquake that ravaged Haiti on Tuesday, January 12, 2010.

Coralie Mevs, a 24-year-old college student and daughter of Dr. Mevs, was eating a late lunch in a fourth floor restaurant at the Hotel Montana with her cousin when the ground began to tremble. Coralie was impacted from the left side with metal and cement pilings. She lay with her legs twisted above her head, falling in and out of consciousness for the next hour.

“After the earthquake I took my shoes

off and ran five miles climbing over cement, fallen buildings and cars until I got to the Hotel Montana,” said Dr. Mevs. Coralie had already been pulled out of the rubble by the family driver when Dr. Mevs reached the hotel. She concluded that Coralie had both back and neck problems, but was not severely injured. Knowing that there was no immediate means to transport Coralie to a medical facility, Dr. Mevs stabilized her daughter and then began to pull others from the collapsed hotel.

Coralie’s condition steadily began to worsen over the next hour. “My eyes were like two bicycles, I was vomiting and bleeding from the right eye,” said Coralie. During this time, Dr. Mevs’ son-in-law, who was with them at the hotel, received a call from Dr. Green. He began to describe Coralie’s condition to Dr. Green, who immediately diagnosed her over the phone, “she must have had a head trauma. Tell her to sit up at a 45 degree angle and give her a diurectic”.

“Dr. Green was a life saver. He started helping us before he even got here,” said Dr. Mevs.

The next morning, Coralie was transported to the UN field hospital. Dr. Green arrived and confirmed Coralie’s original diagnoses of head trauma and a fractured spine. He told Dr. Mevs, “She(Coralie) has to be medevaced. She has to go to Jackson”.

HaitiA Vital Head Trauma Diagnosis

Greetings From the Chairs of Neurology and Neurological Surgery

Coralie Mevs with her mother, Dr. Marguerite Mevs and Dr. Barth A. Green, after surviving the earthquake in Haiti.

They had to wait another 18 hours before Coralie could be transported to Miami. It was a risk to delay surgery, but Dr. Green sat with Coralie the entire night, stabilizing her neck and making sure she was conscious. “Those first hours and night seemed to go on forever as more and more patients crowded into our small, impromptu field hospital at the UN headquarters,” said Dr. Green.

The following morning, January 14, 2010, Coralie was flown to Jackson Memorial Hospital where she received a total body scan and was diagnosed with four types of trauma. The most prevalent being a moderate head injury with epidural hematoma on the left. It had grown by 30% over three days, was causing headaches and a mass effect on the brain and needed to be removed. She sustained fractures of the spinous processes of the C5 C6 C7 in the cervical spine and fractures of lumbar transverse processes of L2 L3 L4. She also had a blowout fracture of her right orbital floor. Coralie underwent surgery for her head injury by Dr. Ross Bullock, University of Miami Professor of Clinical Neurosurgery and world-renowned neurotrauma surgeon and researcher.

“When I saw the quality of care she received at Jackson, I knew we made the right decision to bring her here. I am so thankful for Dr. Green and Dr. Bullock. You can see that they really care. We have been blessed the whole way.” n

Evelyn F. McKnight Center for Age Related Memory Loss Third Annual Symposium & Donor Wall Dedication Ceremony

On February 3, 2010 The Evelyn F. McKnight Center for Age Related Memory Loss held

their Third Annual Symposium at the Miller School campus in Miami, Florida. The symposium featured lectures on cognitive aging disorders presented by a multidisciplinary team from the Departments of Neurology, Psychiatry and Radiology. Following the symposium, the Neurology Department hosted a Center dedication and luncheon attended by the McKnight Brain Research Foundation trustees, Miller School of Medicine Dean, Dr. Pascal Goldschmidt, as well as Department of Neurology faculty and staff.

Dr. Ralph Sacco, Chairman of the Department of Neurology, stated “The generous support of the MBRF will help us toward understanding and alleviating the age-related changes in memory and brain function”. The Center’s team of scientists, researchers, and clinicians, is led by Scientific Director, Dr. Clinton B. Wright, who noted, “Organizing the presentations helped me see more clearly what we have accomplished, as well as how much there is to do. I am excited to keep pushing our mutual goals forward.”

In 2002, the University of Miami Leonard M. Miller School of Medicine was selected to receive a $5 million gift from the McKnight Brain Research Foundation to create the Evelyn F. McKnight Center for Age-Related Memory Loss in the Department of Neurology, which opened in 2008. The Foundation’s gift, matched by a $3,500,000 grant from the Schoninger family and $1,500,000 from other donors, will help scientists

and physicians at the University of Miami Leonard M. Miller School of Medicine unlock the mysteries of why some people lose memory as they grow older. Among the four Centers/Institutes established by the McKnight Brain Research Foundation in the United States, the UM Center is the only one focusing on translational research. The Center has also established the Neurobehavioral Clinic and Health Aging Program where patients receive comprehensive neurological, neuropsychological, and nursing assessments. Our physicians spend time with both the patient and caregivers to be able to provide the proper medical treatment and support to individuals with memory and other cognitive disorders.

Evelyn F. McKnight, a former nurse, and her husband, William, chairman of the board of the 3M Corporation for 59 years, were interested in the effects of aging on memory. Following his death in 1979 and her death in 1999, the McKnight Brain Research Foundation (MBRF) was founded to continue this passion and support research toward the understanding of memory and the specific influences of the natural aging process. In addition to funding the McKnight Center at the University of Miami, the foundation has also funded three other McKnight Institutes at the University of Alabama, University of Arizona and University of Florida.

J. Lee Dockery, a trustee of the McKnight Brain Research Foundation, noted “The trustees were excited and pleased with the progress being made

in transforming the Center’s research initiatives in the direction of clinical translation. We believe that under your capable leadership the mutual goals and objectives of the research partnerships between the University of Miami, the MBRF and the other institutions supported by the MBRF, will lead to productive collaboration and development of the translational research leading to the understanding and strategies for interventions in age related cognitive decline.” n

McKnight Brain Research Foundation trustees, Miller School of Medicine Dean, Dr. Pascal Goldschmidt, Chairman,

Department of Neurology, Dr. Ralph L. Sacco

HaitiA Vital Head Trauma Diagnosis

The University of Miami, Department of Neurology1120 NW 14th Street/Suite 1361-2Miami, Florida 33136Neurology: 305-243-6732Neurological Surgery: 305-243-6946

This newsletter is published by the Departments of Neurology and Neurosurgery at the University of Miami, Miller School of Medicine in affiliation with Jackson Health System, a Public Health Trust.

Departments of Neurology and NeurosurgeryRalph L. Sacco, M.S., M.D., F.A.A.N., F.A.H.A Chair of Neurology Barth A. Green, M.D., F.A.C.S., Chair of Neurological SurgeryRoberto Heros, M.D., F.A.C.S., Co-Chairman Neurological Surgery Medical Editor, Jacques Morcos, M.D., F.R.C.SDepartment of Neurology Writer Jessica Busquets, Department of Neurological Surgery Writer Kasey HayesPhoto Retouching Enhancement Roberto SuazoGraphics Design and Layout Eduardo Menjivar

Non-Profit OrgU.S. PostagePAIDPermit No. 438Miami, FL

NeuroFocus

© 2010 University of Miami, Miller School of Medicine. All Rights Reserved

In The NewsDr. Roberto Heros to Receive Prestigious Harvey Cushing Medal May 3, 2010Roberto C. Heros, M.D., professor and co-chair of neurological surgery and residency program director, has been selected as the 2010 recipient of the prestigious Harvey Cushing Medal. The award, established in 1976 and given annually since 1977, recognizes an AANS member for distinguished service in the field of neurosurgery. Dr. Heros, who is internationally known in his field, joined the Miller School in 1995. He served as president of the AANS in 2002-2003, and is a past president of the American Academy of Neurological Surgeons. Dr. Heros will receive the Cushing Medal at a special ceremony on May 3, 2010 during the annual AANS meeting in Philadelphia.

Evelyn F. McKnight Center participating in Third Annual Inter-Institutional Meeting of McKnight Brain Research Foundation (MBRF) Funded Institutions The Evelyn F. McKnight Center for Age Related Memory Loss team at the University of Miami Leonard M. Miller School of Medicine will be participating in the Third Annual Evelyn F. & William L. McKnight Inter-Institutional Meeting of McKnight Brain Research Foundation (MBRF) Funded Institutions being held at the Hilton University of Florida Conference Center, April 28th-30th, 2010. This institute member only meeting, titled “Human Clinical Trials Directed at Age-Related Memory Decline”, will be hosted this year by The University of Florida in Gainesville.

What’s NextClinton Bush Haiti Fund Awarded 500K Grant to Dr. Green’s EffortsThe grant, awarded in February, is supporting the 240-bed tent hospital at the edge of the Port-au-Prince airport that was spearheaded by Barth Green, professor and chair of neurological surgery and co-founder of University of Miami Global Institute/Project Medishare. The grant is specially being used for the purchase of critically needed items that include a 64-slice CT scanner, dialysis machines, angiographic equipment, and digital X-ray, fluoroscopy, and anesthesia machines.

Faculty ProfileDr. Enrique Serrano has recently joined the Neurology Department as an Assistant Professor of Clinical Neurology in the Epilepsy Division. A graduate of the University of Puerto Rico, he served for four years as a general practitioner and medical officer in the United States Navy. He was then deployed to Iraq serving as the only physician on a naval ship assigned to the Lincoln Battle Group in the Persian Gulf during Operations Enduring and Iraqi Freedom. Following his naval service, he completed his Neurology residency and a Neurophysiology fellowship at the Medical College of Georgia in Augusta, Georgia.Prior to joining our faculty, Dr. Serrano worked for several years in private practice in Louisiana and South Florida. His major subspecialty interest is epilepsy including interpreting routine and ambulatory electroencephalograms (EEGs), evaluating and treating patients with seizures, conducting therapeutic trials of medications for the treatment of epilepsy, and in the pre-surgical evaluation of patients with intractable epilepsy.

Resident Spotlight Platform Presentation at the American Academy of Neurology Meeting 2010

Neurology Resident, Dr. Jose Gutierrez, was recently selected to present his abstract as a platform presentation at the 2010 American Academy of Neurology Meeting being held on April 10th through the 17th in Toronto, Ontario. Dr. Gutierrez’s abstract titled “HIV-Vasculopathy and VZV-Vasculitis as Cause of Stroke in HIV-Infected Patients” studied cases with multiple cerebral aneurysms in patients with HV and VV. His conclusions found that HIV was associated to large-artery disease and hemispheric strokes, whereas VZV only affected small arteries and produced smaller, subcortical strokes. All patients were severely immunosuppressed, but only patients with HIV were on HAART. Jose is enrolled in our Resident Clinician Researcher Program, a program aimed to provide residents with necessary faculty mentorship, administrative guidance, infrastructure and research facilities in order for them to pursue rewarding clinical and basic neuroscience research during the period of residency. While enrolled, he has published several manuscripts and begun coursework for his Masters in Public Health Degree. Jose will be continuing his training as a Fellow in Vascular Neurology at the Neurological Institute at Columbia University College of Physicians and Surgeons.

Platform Presentation at the American Academy of Neurology Meeting 2010 Neurology Resident – Dr. Jose Gutierrez – PGY-3