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How Doctors Treat Brain Emergencies · Meaningful Medicine with Novant Health

• 0:03
  Nolan Alexander (Host): Meaningful Medicine is a Novant Health Podcast
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  bringing you access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I am Nolan Alexander, and today we have Dr.
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  Jafar Hashem, who is a neurocritical care physician with Novant Health.
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  Dr.
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  Hashem, how are you today?
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  Jafar Hashem, MD: I'm doing very well.
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  Thank you, Nolan, and thank you for having me on this great show.
• 0:39
  Nolan Alexander (Host): It's our pleasure.
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  Let's jump into it.
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  What are some signs of a brain emergency, like stroke or aneurysm that
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  people should seek immediate care for?
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  Jafar Hashem, MD: Yes.
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  One of the most important things for people to understand, when thinking
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  about brain emergencies, And the signs that are related to that, are that
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  they are often sudden and dramatic, but sometimes they can also be subtle and
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  that's what can make them dangerous.
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  So for a stroke, commonly we use a monic known as the B Fast.
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  B stands for balance problems or sudden dizziness.
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  E stands for eye, you know, so visual symptoms, sudden
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  vision loss or double vision.
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  F is for face, facial drooping.
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  A is for arm or leg weakness, especially on one side more than the other.
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  S is for speech difficulty.
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  So slurred speech or having trouble finding words and T is actually
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  the time to call nine one when you feel any of those symptoms.
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  And beyond that, you know, of course This is a good, For all intents and
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  purposes, a good mnemonic to be aware of.
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  But there are some other things to kind of watch out for that, essentially any sudden
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  neurologic change, confusion, inability to understand language, a severe headache
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  that comes out of nowhere unexpected.
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  Sometimes people might describe that as the worst headache of their lives.
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  That can also be a sign of something serious, such as a ruptured
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  aneurysm Ultimately, what makes this challenging is that symptoms don't
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  always fit to a strict checklist.
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  That's why it's one of the biggest, and important takeaways here is that if
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  something feels abrupt, severe, off, out of character, don't try to wait it out.
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  Don't try to explain it.
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  The brain doesn't give many second chances, and that's where calling 9 1
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  1 gets you to the right care faster, And that speed is what directly affects
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  what treatments are available and how well someone ends up recovering.
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  It's always better to be evaluated and told that everything is
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  okay than to miss a real brain emergency where time truly matters.
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  Nolan Alexander (Host): Let's dive into that just a little bit more.
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  Why is getting fast care so important in these cases?
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  Jafar Hashem, MD: fast care is very important.
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  as we say in neurology, we have a, famous saying that time is brain.
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  That phrase really captures the urgency of those situations.
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  As we said, the brain doesn't really give a whole lot of second chances,
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  so getting fast care is critical.
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  Many of the emergent treatments that we offer really work if we only act early.
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  because what happens after the initial brain injury can also be just
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  as important as the injury itself.
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  So to go a little bit more into that, the first thing that happens
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  when we have the symptoms happen is the primary brain injury.
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  This is the initial event.
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  So for example, a blood clot that blocks one of the arteries to the brain
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  and, causes a stroke or that aneurysm that ruptures and causes the bleeding.
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  the brain cells begin to suffer right away immediately.
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  the longer that goes on, then the more injury that can occur.
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  once brain tissue is lost, unfortunately.
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  It is really hard to bring that back.
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  And speed is what gives us access to treatments that can directly limit
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  the damage and improve the outcome.
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  if I were to give a couple of examples that would kind of be
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  quite relatable, is stroke one of the biggest things that we see?
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  there are two major types.
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  the ischemic type where there is a blood clot that.
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  Limits blood supply to the brain.
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  And blood supply is cut off.
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  and that's where our treatments are really limited by time, early on,
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  whereas the most common treatments that we use are clot dissolving
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  medications known as thrombolytics.
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  And mechanical thrombectomy where the clot is typically removed,
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  through, mechanical means.
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  So the sooner that blood flow is restored to the brain, that means
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  the more brain tissue weaken save.
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  And that really translates into a person's ability to speak
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  better, understand better, move eventually, and get their life back.
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  Similar for bleeding emergencies such as an aneurysm rupture, where
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  securing that aneurysm early on is of paramount importance so that we
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  don't want to see that bleeding again.
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  and there are other neurosurgical interventions that can help
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  limit the extent of the injury that happens afterwards.
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  such as, pressure relieving options, whether that through drains,
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  drainage, or surgical decompression.
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  To allow the brain room to swell safely.
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  All these things can help prevent what we, what is known as secondary brain
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  injury after that initial event that can cause further worse outcomes.
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  That usually runs on the course of hours to days, but essentially
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  it all starts from the beginning.
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  If we start right early on and set things up the right way, then hopefully
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  that improves the course to follow.
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  Nolan Alexander (Host): So in addition to strokes and aneurysms, what are
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  some of the most common reasons a patient may need neurocritical care?
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  Jafar Hashem, MD: Some of the most common reasons that patient's need
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  neurocritical care are variable.
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  believe it or not, most of our patient's, they don't plan
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  on coming to the neuro ICU.
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  They don't make appointments ahead of time.
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  These are people who are just living their normal daily lives and.
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  Just hours earlier before something life-changing like this happens.
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  The most common reasons that we see ultimately are strokes.
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  So ischemic strokes is one of the most common things we see as we
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  kind of explain That is blood clot, blocking the blood flow of the brain.
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  other important things are, hemorrhagic strokes, which is
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  essentially bleeding into the brain.
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  That could be from various causes.
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  Importantly, ruptured brain aneurysms, traumatic brain injuries,
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  prolonged uncontrolled seizures.
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  Brain swelling from other causes, such as infection, lack of oxygen,
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  and a very common, thing that we see is, surgical patient's.
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  So patient's who are there for brain surgery, going a little bit more
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  into those, you know, just, the, severe strokes that we see are often,
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  patient's that need to be in the ICU.
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  They can't be in any place outside of the ICU.
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  That's where, we have close monitoring that we're able to follow them
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  for any expected complications that may happen afterwards.
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  in the case of, severe stroke from ischemic, blood clots, we kind
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  of explain the common treatments that we do, which is essentially.
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  Clot busting medications to break up that clot or mechanical thrombectomy
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  where the, neurointerventionalists would actually go in through the vessels,
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  work their way up to the brain and actually retrieve that blood clot.
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  bleeding in the brain as we kind of talked about, the most common thing,
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  we see is related to blood pressure or other risk factors, but one of the most
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  concerning ones that we see is ruptured aneurysms, subarachnoid hemorrhage.
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  these often require very urgent procedures to stop the bleeding
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  And then followed by the close monitoring to prevent complications.
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  uncontrolled seizures are also a fairly common thing that we see.
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  So, Oftentimes people can have seizures that stop on their own, but there are
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  times when those seizures don't stop and it turns into a medical emergency.
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  Patient's can't breathe.
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  And then a whole host of metabolic issues come after that.
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  That can be life-threatening.
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  Those patient's need to be, in a neurocritical care setting for
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  continuous brain monitoring and carefully titrating those medications
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  to prevent se seizures from coming back.
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  we briefly alluded to major neurosurgical procedures.
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  Those include brain tumors, major spine surgeries that specifically
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  affect the spinal cord and complex vascular conditions such as, Unruptured
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  brain aneurysms, AVMs, or arterial venous malformations of the brain.
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  they can require minimally invasive surgeries or endovascular procedures.
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  traumatic brain injuries are important cause also, and, less common.
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  Things that we see include severe brain infections, such as meningitis,
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  encephalitis, post cardiac arrest if, someone's heart, suffers a
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  cardiac arrest, for example, outside of the hospital, that can affect
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  the brain because it's not getting enough blood supply and, neuromuscular
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  conditions, such as myasthenia gravis and guion beret syndrome, GBS, that
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  can affect the person's ability to.
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  Breathe because of the weakness.
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  all in all, the neuro ICU exists because these conditions
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  require more than just routine.
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  General ICU care, we're talking about specialized, dedicated neuromonitoring.
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  that includes focused nursing care, continuous, EEG, intracranial
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  pressure monitoring, a portable head ct, and doppler ultrasound.
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  These are the various.
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  Modalities that are used in the neuro ICU for monitoring And the brain function
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  and, knowing how to catch something early and to, react to it as soon as possible
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  if we see that so that we can improve the outcome and, you know, prevent further
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  damage from happening to the brain.
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  and rapid decision-making is, and a team That is trained to recognize That
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  is, how we prevent long-lasting damage.
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  Nolan Alexander (Host): Dr.
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  Hashem, I know firsthand some of the situations that would land someone in
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  your unit can be pretty scary for both patient's and their loved ones brain
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  injuries, depending on the severity that can have lifelong impacts.
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  How did the care teams guide patient's and families through these serious events?
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  Jafar Hashem, MD: Yes, these events are really frightening.
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  And we never truly lose sight of that.
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  This is one of the most human parts of medicine.
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  Patient's and their families often meet us on, you know, one
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  of the worst days of their lives.
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  and they're being asked to absorb a lot of information at a time where
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  emotions are running at an all time high.
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  So being able to support patient's and families during some of their most
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  vulnerable moments is a responsibility that we don't take lightly.
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  one of the most important things we do is try to slow the experience
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  down for the families, even when medically things are moving very fast.
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  We focus on clear, honest communication, explaining what's going on, what we're
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  worried about, what may happen, what we know, and more importantly, what we don't
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  know And what we're watching out for.
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  So in plain language, without rushing, without sugarcoating, And we expect to
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  repeat ourselves quite often we're glad to do it because no one is expected to absorb
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  that much of information in a sudden.
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  ultimately, our main goal is to make the families, our partners So that means
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  inviting questions, checking that they are understanding regularly, helping them
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  feel grounded in what is happening day to day, rather than feel overwhelmed by
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  the uncertainty of the whole journey.
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  when difficult questions and decisions come up.
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  We take time to understand the patient as a person, their values, their
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  wishes, And what matters most to them.
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  No two people are the same.
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  We often say that, so our goal is to make sure that the care That is being provided
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  stays aligned with who that person is and not what is just medically possible.
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  So That is the human side of things.
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  And, our teams really try to pay close attention to those
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  small but meaningful details.
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  And that connection helps families feel, seen, heard, and it reminds
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  us that we're caring for a person and not just a diagnosis.
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  we can't always control the outcome, but we can make sure that families never
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  feel alone, unheard or rushed through decisions that really matter deeply.
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  Nolan Alexander (Host): I wanna shift the focus on what happens after a
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  patient is stabilized in the neuro ICU.
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  What does recovery look like?
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  For example, could patient's need physical rehabilitation or speech
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  or occupational therapy services?
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  Jafar Hashem, MD: Yes.
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  Great questions.
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  Once a patient is stabilized, recovery is really the next part of their journey.
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  the short answer really is that the recovery can look
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  different for every person.
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  For some patient's, stabilization means that they're ready to move
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  outta the ICU fairly quickly.
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  And you know, sometimes that can be the next day, as soon as the next day or
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  the next, you know, coming few days.
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  some even do so well as to be able to go home the next day.
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  They are a minority of patient's, but these are the real success
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  stories that we thrive on.
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  for example, someone who comes in with an acute stroke and undergoes those,
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  clot retrieving and clot busting medications that we talked about and.
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  They end up doing well early on.
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  but again, that's not all our patient's And we understand that,
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  and This is part of what we do.
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  really what determines a lot of the timeline is how the brain is healing
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  and whether there is ongoing risk for further complications such as swelling.
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  Bleeding or seizures, those things can be difficult to predict at first.
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  but that's why we have the patient with us for, under close observation, whether
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  it's a day, a month or more, achieving meaningful recovery at the end of the line
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  is what we really, we really want to see.
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  And what we really care about.
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  now, recovery overall does involve a team-based rehabilitation approach.
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  So this does include physical therapy, to help regain strength, balance, mobility.
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  occupational therapy helps with regaining the ability to perform daily activities
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  such as dressing, eating, and speech therapy to work on communication.
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  thinking skills, speaking and swallowing, which is very commonly affected in our
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  neurologic patient's in many cases, You know, the therapy does start really early
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  on and earlier than most people expect.
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  sometimes while patient's are even still in the ICU, we like to introduce that as
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  early and as safe as possible to do so, because early rehabilitation can make a
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  meaningful difference on the long-term.
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  It is also important during that process to set realistic
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  expectations, and realistic goals.
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  brain recovery is rarely linear, And the truth of it is that there can be
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  good days and there can be bad days.
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  and progress may happen in small steps rather than big leaps.
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  This is all part of it.
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  We often educate families that This is to be expected.
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  Also, it is part of the normal process and, we embrace time
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  as, A commodity so that we can hopefully achieve a better outcome.
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  Our role is to really to help guide that transition through
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  the process And the unknowns.
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  and many patient's really end up recovering far more function
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  than initially we expect.
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  so we don't give up wherever we see a path forward or any sort of meaningful
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  outcome, we fight hard for it.
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  that's what's most meaningful to us, in our practice.
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  Nolan Alexander (Host): As we prepare to close, I'm curious, I
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  want to ask how Neurocritical Care became a passion of yours.
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  What drew you to this specialty?
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  Jafar Hashem, MD: Thank you, for asking that.
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  I've always been curious about, how complex things work.
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  I've always been fascinated by the workings of the brain.
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  That's what initially drew me into the field of neurology overall.
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  the, brain is just incredibly complex and even after years of training,
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  there's still a lot to learn.
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  there's a lot that still surprises us and, that includes also
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  patient's and their outcomes.
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  And But a little bit of a, more of a background about me starting medicine
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  or going to medical school, I was a classically trained, musician, violinist.
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  I've played with the Jordan National Orchestra.
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  That's where I was originally from for many years.
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  and really that experience helped.
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  Shape a lot of my perspective, on neurocritical care.
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  if I were to draw parallels, in an orchestra, there is no single
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  instrument that carries the whole piece.
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  so everyone has to listen to stay in sync, to adjust to one another.
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  And when it works, it becomes something beautiful, harmonious
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  symphony That is bigger and more powerful than any one part alone.
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  And the neuro ICU essentially, to me feels the very much the same.
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  Every patient is at the center of our care.
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  The care teams work together with everyone revolving around them.
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  That includes our nurses, therapists, pharmacists, surgeons, And the physicians.
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  We're each playing a different role, all focused on the same goal eventually.
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  So when everyone is aligned, the care becomes coordinated,
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  thoughtful, and effective.
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  we want to restore hope, provide a path for recovery, and
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  humanize care as best as we can.
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  And That is where I found my true calling in neurocritical care,
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  where urgency, complexity, teamwork, and meaning all come together.
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  Nolan Alexander (Host): What a.
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  Thank you so much for your time and insight today, Dr.
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  Hashem.
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  Jafar Hashem, MD: Thank you very much for having me.
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  I really enjoyed this.
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  Nolan Alexander (Host): That was Dr.
• 17:45
  Jafar Hashem, who is a neurocritical care physician with novant health To find
• 17:50
  a physician, visit novant health.org.
• 17:53
  For more health and wellness information from our experts,
• 17:56
  visit healthy headlines.org.