Last year Lynda Etheridge was feeling fine and saw no need for a doctor-recommended brain scan to see if she had an aneurysm. Today she’s glad that her husband, Herb, convinced her to do it.

The Etheridges, of North Little Rock, had seen Lynda’s brother undergo recent surgeries for three ruptured brain aneurysms and endure a long, difficult recovery. She was told by her brother’s doctor in Houston that aneurysms run in families and that she should be tested.

Her husband urged her to follow through, and she got a nudge from her internist, so she agreed. In May 2009, she got the results of her CT scan.

“They called me the next day and told me I had an aneurysm,” Lynda said. “I was shocked.”

Lynda was referred to a Little Rock neurosurgeon. But instead of taking her case, he recommended that she see UAMS’ Dr. Eren Erdem, an interventional neuroradiologist who specializes in non-surgical catheter-based treatments of brain aneurysms.

Meanwhile, Lynda was considering her options. “I thought I would have to go to Houston or the Mayo Clinic or someplace like that,” she said. “But the neurosurgeon told me Dr. Erdem is the best in the business.” About the same time she went for a mammogram, and her radiologist, who was familiar with Erdem’s work, told her, “Dr. Erdem is excellent.”

Erdem is the only board-certified interventional neuroradiologist in Arkansas, and his skills have been recognized internationally. At UAMS, he directs the Division of Interventional Neuroradiology, where he provides a non-surgical alternative to repair both ruptured and unruptured aneurysms. He also is well known in his field for treating vascular malformations of the head and neck and using an innovative procedure known as kyphoplasty to help multiple myeloma and osteoporosis patients who are immobilized by painful vertebrae fractures. In fact, Erdem leads the world in the number of multiple myeloma patients treated with kyphoplasty.

To treat aneurysms, Erdem uses a relatively new procedure known as coil embolization. During this procedure, a catheter is inserted in a major blood vessel in the inner thigh and maneuvered all the way to the brain. The coiled wire is threaded through a catheter sheath to the aneurysm. The coiled wire is added until it fills the aneurysm, and is left there, permanently. A clot forms around the coils like scar tissue, which blocks more blood from entering the aneurysm.

More often than not, this is the preferred alternative to surgery for ruptured aneurysms, Erdem said. In a surgical procedure, a neurosurgeon has to manipulate brain matter to reach the aneurysm and clip it so that blood stops flowing into the aneurysm. Such invasive surgery has more risks than coil embolization, and the recovery period is significantly longer.

At her first appointment with Erdem, Lynda said she grilled him about the procedure before concluding that UAMS was her best alternative, especially since it allowed her to stay close to home.

Her aneurysm was not ruptured, but Erdem told her that it had a very high risk of rupturing within six months. She had the coiling procedure two weeks later and went home the following day. She said she was able to resume her normal, active routine within three weeks.

“I feel great,” she said. “I’m doing everything I’ve ever done before.”

One afternoon Grace was gardening in her backyard in Springdale, Arkansas. While digging up a plant to give to a co-worker, she felt a fierce pain. “It felt like my head exploded,” she said. “At first, I couldn’t imagine what it was. I was really scared.”

The pain started going down her neck, so Grace thought she could be having a stroke. Grace knew she wasn’t able to drive, so she walked to her neighbor’s house to ask for help. Her speech was slurred, and right away the neighbor knew something was terribly wrong. Grace’s neighbor drove her to the local hospital, and a CT scan revealed a brain aneurysm. Since her local hospital was unable to treat a condition of this nature, Grace was airlifted to UAMS.

Grace was in intensive care until the procedure was performed. She was not allowed to watch TV or do other simple activities that might stimulate her brain and cause further bleeding. But Grace’s family could be there to comfort her, and that included her granddaughter, Isabella. “Everybody was so kind. They allowed my grandbaby to sleep in my arms,” Grace said.

Grace was comforted by the high quality of medical care she received from her UAMS physician, Dr. Eren Erdem. “He had a kind and gentle voice, and he explained all the pros and the cons,” Grace said.

“All my questions were answered. I never thought I wasn’t going to make it. They were confident of the procedure, and I was confident in their abilities.”

Since her aneurysm was already ruptured, the best course of action was to undergo endovascular coiling. This involved a catheter going through her groin area, and then being navigated through blood vessels up to the aneurysm. The coils, which are made of soft, platinum based hair-thin wires, are then wound into the aneurysm like a ball of yarn. Over time, the coils become a dense mass that prevents blood from going to that area and causing more damage. Eventually the coils turn into scar tissue.

The procedure has only been actively performing for about 15 years, Dr. Erdem explained. He has been performed the procedure for 10 years at UAMS. “Studies have shown that there is a better outcome with this minimally invasive surgery,” he said. “The patient recovery time is much faster.” Without the minimally invasive techniques, Grace’s quality of life would have been affected for months. Now this surgery is being used more frequently to treat brain aneurysms and has become the preferred method of treatment for ruptured aneuryms.

Grace’s procedure was performed on Isabella’s first birthday. “Everybody at UAMS was sensitive to that and let me be with my granddaughter,” she said. She spent a week in the hospital following the surgery, and she was grateful that the staff allowed Isabella to be there and help in the recovery process. “I couldn’t have asked for a nicer environment to have this done. It meant so much to be treated with such kindness, understanding and compassion. I don’t think that people in Arkansas realize the top notch health care we have available at UAMS.”

Since her surgery, Grace has shown no signs of complications. She feels that her attitude and outlook definitely helped her recovery process. She said that the procedure made her look at life differently. “It has made me realize the importance of the time that Isabella and I have and that we are able to build memories together.”

Grace has completely returned to normal activities including participating in many community activities. She has also helped other patients who have gone through what she did. She meets with people in the Springdale area who have shared her experience so that they can support and encourage each other.

Grace is extremely grateful to the treatment and care she received at UAMS. “Everybody at UAMS was wonderful to my children and grandchild. I owe my life to UAMS and Dr. Erdem,” she said.

Interventional Radiology
Department of Neurology

Jackson first noticed a problem in 2001 when she began experiencing blurred and double vision, as well as numbness in her feet. “I didn’t really pay much attention to it, because it seemed to go back to normal,” said Jackson, who was 19 at the time.

However, when Jackson’s blurred vision returned a few months later, it didn’t go away. An athlete at Philander Smith College, she had to quit the basketball team. Her eye doctor sent her for an MRI, which showed significant neurological damage.

“When they told me I had MS, I didn’t even know what that was. It was so unreal.”

MS is a disease in which the body’s immune system mistakenly attacks normal tissue, resulting in a loss of muscle control, numbness, difficulty with balance and vision problems.

For Ambra, MS progressed quickly, putting her in a wheelchair and forcing her to drop out of college. “I would fall because I would lose my balance and because my feet were numb,” she said. “The first time I saw Dr. Lee Archer I was in the wheelchair, and we didn’t know if I would walk again.”

Archer, associate professor in the UAMS College of Medicine’s Department of Neurology, started Ambra on chemotherapy and medication, and soon she surprised everyone by walking unassisted.

“The treatments I received at UAMS really turned me around,” said Ambra, who has since re-enrolled in college and hopes to become a rehabilitation counselor to help other people experiencing similar medical challenges.

One of those people is Clay, her younger brother by four years. After experiencing headaches and problems with balance, Clay was diagnosed with MS in 2004 and also is Archer’s patient. “We take it one step at a time,” said Clay, whose condition has stabilized thanks to regular infusion treatments and medication.
 
Together, Jackson and Clay give credit to their mom and Archer for their unending support. “During the hard times, our mother has been our strength when we are weak,” Clay said. “And Dr. Archer is the best. Of all the doctors I’ve ever seen, he cares the most.”

“I can’t thank UAMS enough for giving me the chance to keep on living and loving my wife and kids.”

However, that very same night, Williams’ life took an unexpected turn. While getting ready for bed, he experienced a seizure and lost consciousness. His wife, Rhonda, called 911, and what followed took their lives down a path they never imagined.

“After they ran some tests, the doctor came in and told me that I had a brain tumor,” Williams said. The doctor informed him that while the tumor was probably benign, it was deeply embedded and definitely inoperable. He was prescribed seizure medication and discharged.

Fortunately for Williams, a friend recommended that he get a second opinion from Dr. M. Gazi Yasargil, professor of neurosurgery at UAMS. Internationally recognized for his expertise in disorders of the brain and central nervous system, Yasargil was named Neurosurgeon of the Century in 1999.

After reviewing his condition, Yasargil told Williams exactly what he hoped to hear. “Dr. Yasargil said that he felt sure he could remove the tumor and that I could lead a normal life. It felt like a miracle to hear those words,” Williams said.

Yasargil successfully removed the tumor but in the process made the unexpected discovery that it was a moderate grade tumor that would require radiation and chemotherapy.

After successful treatment, Williams was back to a normal routine and enjoying time with his friends and family. “I’m still taking it easy,” he said. “I don’t get to work or exercise the way I used to, but I’m just so happy to be here.”

He hopes his experience will help others see the value of second opinions. “Don’t ever give up. If you’re not happy with a diagnosis or a prognosis, don’t stop until you’ve exhausted all of your options,” he said. “I can’t thank UAMS enough for giving me the chance to keep on living and loving my wife and kids.”

While suffering a major stroke at her home near Mena, Iva Sikes assumed the worst, not knowing that a UAMS-led telemedicine program would provide her a complete recovery.

Sikes, who lives alone four miles outside of Mena, was about to tend her flower garden June 1 when the left side of her body went numb, causing her to fall.

Her only hope of recovery was to get the right diagnosis from a stroke neurologist so she could receive t-PA, the only FDA-approved drug that could break up the blood clot that was starving her brain of oxygen and nutrients.

And it had to be done within three hours.

Sikes, 89, was wearing a lifeline, a communication device that allowed her to summon her grandson and an ambulance.

“I was sinking fast,” she said just 10 days after the stroke. “I told my grandson, ‘I’ll not be here long.’ My body, my mind, everything was sinking.”

Had her stroke occurred just nine months ago, her chance of recovery would have been slim, said Salah Keyrouz, M.D., Sikes’ stroke neurologist at UAMS.

Starting Nov. 1, Mena Regional Hospital was among the first of now nine hospitals to join the Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support) program, which links rural hospitals to stroke specialists at UAMS and Sparks Health System in Fort Smith. The program is administered by the UAMS Center for Distance Health, which was created by Curtis Lowery, M.D., chairman of the UAMS Department of Obstetrics and Gynecology.

Stroke neurologists are on call 24 hours a day, and remote hospitals participate at no cost.

Keyrouz, medical director of the SAVES program, took the call from the Mena hospital after Sikes arrived. He was able to communicate via real-time two-way video with the local hospital medical staff and Sikes. He also was able to view her high-definition brain CT images taken at the hospital.

“In addition to her left-side paralysis, she had lost peripheral vision on the left side, too,” Keyrouz said. “I knew then that she had a large stroke.”

Despite her advanced age, Keyrouz determined that she was a good candidate for the clot-busting t-PA. It was important that Sikes was able to tell him definitively that the stroke had occurred at 9:30 a.m., which meant the drug could be given within the critical three-hour window. Patients who wake up with a stroke, for example, and don’t know when the stroke began are not eligible to receive t-PA.

“If you can intervene very early on, there’s a chance that you can melt the blood clot by giving this very powerful medicine,” Keyrouz said. “If you do it beyond three hours, there is potential that you’re irrigating an area of the brain that’s irreversibly dead. The risk of bleeding is also high.”

Sikes and her family agreed to the t-PA treatment after Keyrouz informed them that it would give her roughly a 30 percent chance of improvement, but a 2 percent to 6 percent chance of bleeding in the brain.

“This is a lady who was independent, going about her activities and enjoying life,” Keyrouz said. “Without the medication, there was a very big possibility that she would live the rest of her life paralyzed, not feeling anything on her left side and with slurred speech.”

Twenty-four hours after receiving the t-PA, Keyrouz followed up with Sikes using telemedicine.

The exam showed that Sikes had almost completely recovered. The paralysis was gone, her peripheral vision had returned, and her speech was nearly back to normal.

“The nurse would touch her with a pin on the left and right, and she was feeling perfectly normal on both sides,” Keyrouz said. “She just had mild weakness in the left arm and left leg. She had such a remarkable recovery.”

Sikes said she was surprised by her recovery and grateful for the technology that helped save her.

“It’s just so wonderful, I’d like to tell the world,” she said of the SAVES program. “I’m here today because of my lifeline and the medication I didn’t know anything about.”

The SAVES program is made possible by partnerships between the UAMS Center for Distance Health, the state Department of Human Services Division of Medical Services and Sparks Health System in Fort Smith. The program was established with a one-year, $6.1 million DHS Medicaid contract. Since the program began in November, there have been 38 SAVES consults and four patients have received t-PA.

The nine hospitals participating in the SAVES program so far are: Baptist Health Medical Center – Arkadelphia, White River Medical Center in Batesville, Baxter Regional Medical Center in Mountain Home, Booneville Community Hospital, DeWitt Hospital, Johnson Regional Medical Center in Clarksville, McGehee-Desha County Hospital, Helena Regional Medical Center and Mena Regional Health System.

Additional hospitals across Arkansas will be added in the coming months, said Lowery, director of the UAMS Center for Distance Health.

The most recent statistics from the national Centers for Disease Control and Prevention show that Arkansas had 1,847 stroke-related deaths in 2005, which dwarfs Arkansas’ other major causes of death. Arkansas ranks third highest among all states in stroke deaths, with 61 per 100,000 residents. Only Alabama and Tennessee had a higher number. The nationwide direct and indirect cost of medical and institutional care of permanently disabled stroke victims was $57.9 billion in 2006.

When UAMS patient Glen Deaton arrived at UAMS, large veins that drain blood from his brain were clotting. Salah Keyrouz, M.D., a UAMS stroke neurologist and Glen’s doctor, described it as the worst case he had ever seen. “I didn’t think he was going to make it,” Dr. Keyrouz said. stroke caused by a clot that in Glen’s case ran from the top of his head nearly to his neck. Glen subsequently had a seizure, became unresponsive and had to be put on a ventilator.

An MRI revealed cerebral venous sinus thrombosis – a type of

Keyrouz called on UAMS’ Eren Erdem, M.D., director of interventional radiology, and Mollie Atherton, M.D., interventional radiology fellow. Drs. Erdem and Atherton had a breakthrough in Glen’s treatment when they next tried a new catheter device that was acquired only months before by UAMS.

As with the previous catheter attempts, Atherton and Erdem threaded the tiny device into a leg vein and all the way into the brain. “I was amazed at how quickly it dissolved the clot,” Atherton said. “We were able to restore blood flow within about an hour.”

The next day Deaton, 42, awoke from his coma, and a few months later, he was nearly back to full strength.

“I’m a little beside myself, thinking about how bad it was. I’m glad I came to UAMS, and I’m glad they could help.”

William Culp, M.D., who is leading a NIH-funded research of new stroke therapies at UAMS, stated that Glen’s treatment is a case where research helped the clinical care, and it took a team to make this happen.

Bruce Bell is proof that a person’s life can change in an instant.

While applying weather-proofing material to the ceiling of a building in Pine Bluff, Bell fell 20 feet, landing on his back. No one witnessed his fall, and it is estimated that it took his employees about 10 minutes to find him. “I wasn’t breathing, and my lips and hands were blue,” Bell said.

He was taken to a local hospital, where doctors quickly determined he should be transported to UAMS — a move he believes saved his life. 

“I couldn’t have picked any better people to take care of me.”

Bell’s injuries included a broken neck and a dislocation of the base of his skull and cervical spine. A very low percentage of people survive such an injury, and those who do often experience severe brain damage as a result.

Dr. T. Glenn Pait, director of the UAMS Jackson T. Stephens Spine & Neurosciences Institute and professor of neurosurgery and orthopaedic surgery, performed the delicate surgery to reattach Bell’s skull to his spine. “My condition was pretty grim,” Bell said. “I was so blessed to have Dr. Pait. He took excellent care of both me and my family.”

Under the supervision of Dr. Thomas Kiser, now an associate professor in the UAMS Department of Physical Medicine and Rehabilitation, Bell underwent inpatient physical and occupational therapy for about two months. Within six months he went from being unable to move to talking and walking with assistance.

Nine years later, Bell’s favorite activity is spending time with his wife and three kids. He even hopes one day to run a 5K.

“It was a complicated injury, but everyone always remained positive that I would recover,” he said. “You have to keep fighting.”