ROCKVILLE CENTRE, NY – Cheung Wong, a 45-year-old father of five from Valley Stream, NY, is alive and functioning today thanks to the expertise and dedication of his health care team, the support and perseverance of his family, and the use of hypothermia to control potentially fatal brain swelling.
Treatment with hypothermia for neurological disorders has been extensively studied and accepted by the neuroscience community as an effective treatment. It is still considered relatively new by many working in other fields, although it has been used for a number of years, and is widely accepted, as a treatment for heart attack victims. Nonetheless, hypothermia is being used successfully at more and more hospitals to treat neurological conditions such as brain swelling (edema), stroke and brain trauma. Fortunately for Mr. Cheung, it was available in the hospital where he was treated.
Mr. Cheung’s ordeal started on a cold day in February 2013. As he drove home from the restaurant he owns, the left side of his body suddenly felt weak. He had strange sensations on both sides of his face and he became confused. He pulled over and called his son, who drove him to the emergency room of Mercy Medical Center in Rockville Centre, NY. What came next was a long ordeal, which fortunately ended far better than anyone expected on that cold February day.
At the hospital, doctors suspected Mr. Cheung was having a stroke, and gave him blood clot-dissolving medications. The infusion had to be stopped, however, because Mr. Cheung developed very high blood pressure. He remembers the IV being inserted into his hand, but little else after that.
Mr. Cheung was admitted to the hospital’s ICU, where an MRI showed that he had a massive right hemispheric stroke and a blocked carotid artery. His brain started to swell despite aggressive medical treatment.
Neuro-intensivist (neurologist working with critically ill patients) Ivan Mikolaenko, M.D., F.A.A.N., from the Neurological Surgery, P.C. (NSPC) private practice, was in charge of Mr. Cheung’s care. Seeing that his patient’s condition was rapidly deteriorating, Dr. Mikolaenko called NSPC neurosurgeon Robert N. Holtzman, M.D. to perform a decompressive craniectomy – a procedure in which part of the patient’s skull is removed, in order to allow the brain to swell and to release pressure that can lead to permanent brain damage.
“His pressure was really high,” said Dr. Holtzman. “The stroke was devastating and he had developed left-sided paralysis.”
Mr.Cheung tolerated the procedure well and his condition improved slightly. Unfortunately, the next day he worsened again, as his brain continued to swell and started to push on the opposite, intact healthy brain hemisphere. “He also had no movement of his extremities at this point, and his pupils were barely reactive,” said Dr. Holtzman.
Another NSPC neurosurgeon, Sachin N. Shah, M.D., came in and inserted a drain to further help with the removal of spinal fluid. Dr. Holtzman suggested that Mr. Cheung be given medications as well.
Dr. Mikolaenko thought Mr. Cheung might be rescued by using a body cooling system known as “Arctic Sun.” He was aware that Mercy Medical Center had this system in place for cardiac arrest patients. Knowing that the system was shown in major studies to decrease brain swelling when used early in severe brain injury, Dr. Mikolaenko asked hospital administration to allow him to use it to help save Mr. Cheung’s life. Using this lifesaving technology, the team kept Mr. Cheung at 34 degrees Celsius for four days – and stopped his brain from swelling during the critical initial period of his brain disease. Mr. Cheung became the first patient at the hospital to benefit from therapeutic hypothermia to treat malignant brain edema caused by a large stroke.
Mr. Cheung was still not out of the woods, however: the doctors had to run the cooling system for another 10 days just to keep Mr. Cheung’s temperature normal, as any fever would cause harm to his already injured brain. Eventually, his brain swelling slowly started to resolve. He was transferred to an acute rehabilitation center and then to an extended care facility where he was weaned from artificial breathing and feeding tubes, and went through inpatient rehabilitation for a number of months.
His mental status improved significantly and, despite the fact that he lost 3/4 of his right hemisphere due to stroke, his most important deep brain structures were rescued. Mr. Cheung resumed most of his independent activities, and now only has a problem moving his left arm and walks with a cane. No other known physical or cognitive disabilities related to the stroke or the brain swelling persist. In September, Dr. Holtzman sealed up the area where Mr. Cheung’s skull bone had been removed, the last step in his edema treatment.
“I feel wonderful now, and hope to go back to work,” said Mr. Cheung, who will continue to go to outpatient physical therapy for his left arm. “I am grateful to Dr. Mikolaenko, Dr. Holtzman and the team for saving my life.” He is also thankful to his family for not giving up hope.
“This case shows that the neuroscience team approach in treatment of severe brain diseases can result in a miraculous recovery,” said Dr. Mikolaenko.
Dr. Holtzman said, “Mr. Cheung’s case is an inspiration for other people who’ve had a stroke, as well as for health professionals. I have been a neurosurgeon for 40 years, and this shows that you should never give up hope. You never know when an irreversible point has been reached.”