Symptoms of a Stroke

F.A.S.T. Stroke Symptoms

Ramin Rak breaks down the F.A.S.T. stroke symptoms.

Ramin Rak practices his advanced knowledge of microneurosurgical techniques at Neurological Surgery P.C. on Long Island.

Here, he specializes in awake craniotomies, spinal surgeries, skull-based surgeries, and treatment of tumors.

More information on these complex procedures can be accessed through his Pinterest page.

A stroke is caused by a disturbance in the blood supply and results in the loss of function.

An ischemic stroke is caused by a clot that obstructs blood flow, while a hemorrhagic stroke is a result of a rupturing blood vessel. A transient ischemic attack can also occur, which is essentially a mini stroke caused by a temporary clot. Both types of strokes are extremely serious, as they are the number four cause of death, and the leading cause of adult disability in the United States.

According to strokeassociation.org, F.A.S.T is an easy way to remember the sudden signs of a stroke:

  • Face Drooping- If one side of your face is drooping or your smile is uneven, it could indicate a stroke.
  • Arm Weakness- When one arm is weak, numb, or drifts downward when your arms are raised, seek immediate medical attention.
  • Speech Difficulty- If someone is struggling to form words or unable to repeat a simple sentence, a stroke may be the cause.
  • Time to call 911- If you are experiencing any of these symptoms, call 911 immediately, even if the symptoms go away.

Beyond these core symptoms, a person may also present numbness of the leg, arm or face; trouble seeing; an unexplained sudden, severe headache; dizziness or loss of coordination; and confusion or trouble understanding.

Quick stroke treatment can save lives, so it is crucial to seek immediate medical attention if you have shown any of the above symptoms. After a doctor makes a diagnosis, they will begin a treatment plan specific to the cause of the stroke.

Skull Base Surgery

Ramin Rak is a board-certified neurosurgeon with years of experience specializing in complex tumors, spine treatments, awake craniotomies, and skull base surgeries.

Skull base surgery is a specialized type of surgery performed to treat tumors and other diseases occurring in certain areas of the skull such as behind the eyes or in the nasal cavity. The skull is made up of bones and cartilage, forming the face and the cranium. The bones that form the base of the cranium also form the eye socket, some of the sinuses, the roof of the nasal cavity, as well as the bones surrounding the inner ear. The base of the skull is a very complex area where many vital parts of the body pass through including blood vessels, nerves, and the spinal cord.

Ramin Rak | Skull Base Surgery

Ramin Rak uses the latest in minimally invasive techniques to perform skull base surgery.

Skull Base Surgery requires a multidisciplinary approach often involving ear, nose, and throat surgeons, neurosurgeons, plastic surgeons, radiologists, pathologists, oncologists, and other specialists. There are two main ways to perform skull base surgery. It may be done through a minimally invasive endoscopic procedure. This involves making a small incision through the natural openings of the skull, normally the nose or mouth. A small hole may also be made just above the eyebrow. Through this method, a neurosurgeon is able to remove the growth through a thin lighted tube referred to as an endoscope. An MRI picture of the skull base will usually be taken during this process to ensure that the entire growth has been removed successfully. The second way to perform skull base surgery is often referred to as traditional or open skull base surgery. This procedure requires making an opening in the skull. Parts of bone may be removed in order to reach the growth and have it properly removed.

Listed below are some of the common growths and conditions that may be treated with skull base surgery:

  • Growths caused by infections
  • Pituitary tumors
  • Sinus tumors
  • Glomus tumors
  • Cysts developed from birth
  • Cerebrospinal fluid leak
  • Meningiomas
  • Chordomas
  • Trigeminal neuralgia
  • Acoustic neuroma

Neurological Complications of Lyme Disease

Neurological Complications of Lyme Disease

Ramin Rak explains the Neurological complications of Lyme Disease.

As a highly skilled board certified neurosurgeon, Ramin Rak has treated a number of conditions involving both the spine and brain.

At Neurological Surgery, P.C., located on Long Island, he has come across a number of cases of Lyme disease. With the condition on the rise, it is important to know how lyme disease is contracted and the damaging effects it can have. More tips like these can be found on Ramin Rak’s twitter feed.

According to an article from Stony Brook Medicine, Lyme disease is an infection caused by the bacterium, spirochete.

It is transmitted by deer ticks, which are found throughout North America, Europe, and Asia. A tick bite, though painless, can cause arthritic complications, as well as neurological and cardiac problems. The longer the tick is attached, the greater risk of Lyme disease transmission.

The symptoms and severity of Lyme disease can vary from person to person.

The most common symptom is a rash, which eventually grows into a bulls-eye shaped ring. Flu like symptoms are also possible, including headache, aching muscles, fatigue, chills, and fever. If treated properly, the complications may end there. Unfortunately, if the tick goes unnoticed, a persons first symptoms may be arthritic, neurological, or cardiac.

Arthritic complications due to Lyme disease include general achiness, pain, and swelling in the joints.

Neurological problems consist of meningitis, memory loss, fatigue, difficulty concentrating, bell’s palsy, and encephalitis. Most patients with flu like symptoms can be completely cured with antibiotics but those with arthritic or neurological symptoms require a more vigorous treatment.

Protect yourself from ticks by:

  • Applying tick repellants
  • Shampoo and shower after being in the woods
  • Keep long hair tucked away
  • Wear long sleeves and long pants
  • Check yourself occasionally
  • More tips on how to defend yourself against ticks can be found here.

Learn more about Ramin Rak and the services he provides by visiting wordpress.com.

Aneurysm Coiling

Hi all, Ramin Rak here with another blog post about a complicated neurosurgical procedure I perform at Neurological Surgery, P.C.: aneurysm coiling.

I primarily treat conditions in the brain and spine so I only perform aneurysm coiling to address brain aneurysms. Endovascular aneurysm coiling is one of two techniques (along with open surgical clipping) that can be used to treat brain aneurysms, but sometimes a physician will choose to closely observe an aneurysm instead of recommending one of these two treatments.

Aneurysm coiling is a minimally invasive endovascular procedure performed to treat an aneurysm, which is a balloon-like bulge of an artery wall (learn more).

As an aneurysm grows, it will thin and weaken until it becomes so thin that it leaks or ruptures. A ruptured aneurysm will release blood into the space around the brain, called a subarachnoid hemorrhage, and is life threatening. Treatment involves stopping blood from flowing into the aneurysm but still allowing blood to flow freely through the normal arteries. While open surgical clipping accomplishes this from the outside, aneurysm coiling does so from the inside.

Ramin Rak Aneurysm Coiling

This diagram depicts the insertion of small platinum coils into the aneurysm using a catheter

I begin the procedure by giving the patient anesthesia while they are on the x-ray table.

Next, I locate the femoral artery and use a needle to insert a long plastic tube (the catheter) into the bloodstream. Dye is then injected through the catheter to make blood vessels visible on my x-ray monitor, allowing me to guide the catheter to one of four arteries in the neck that lead to the brain. After the catheter is placed, I take x-ray photos and use them to take measurements of the aneurysm.

A second smaller catheter travels through the first catheter and makes its way to the aneurysm itself.

Small platinum coils are then passed through the catheter until they emerge in the aneurysm, and this process continues until the aneurysm is completely packed with coils. I then inject contrast agent so that I can confirm that blood is no longer flowing into the aneurysm and finally close the puncture site in the artery.

Endovascular aneurysm coiling has a long-term success rate between 80 and 85%.

Thanks for reading,

Ramin Rak

Learn more about my specialized neurosurgical procedures on Brand Yourself: http://raminrak.brandyourself.com/ or visit my WordPress blog.

Advanced Awake Craniotomy Technologies

Hi all, Ramin Rak here with the latest news about a medical procedure I perform called awake craniotomy.

At Neurological Surgery, P.C. in Long Island, New York, I am one of the leading neurosurgeons performing this procedure. When I conduct an awake craniotomy, I work alongside a team of skilled physicians to operate some of today’s  most advanced neuro-navigational technology. My expertise in micro-neurosurgical techniques has allowed me to successfully establish awake craniotomy programs in multiple hospitals around the Long Island area.

Ramin Rak awake craniotomy

“My colleague tests a patient’s motor skills during an awake craniotomy.”

Awake craniotomy is a procedure in which patients remain awake during brain tumor surgery in order to determine whether the operation will affect specific areas of the brain that control speech, vision, and movement.

Once I identify a patient as a good candidate for an awake craniotomy, I work with the specialized team at Neurological Surgery, P.C. to establish a baseline of cognitive function and precisely pinpoint the tumor’s location. The specialized team is composed of neurophysiologists (who monitor the brain’s electrical impulses), nurses, and physicians assistants to ensure everything runs smoothly. Before operating on a patient, I use a unique mapping approach to map the brain’s gray matter and nerve fibers within the white matter. Mapping techniques have helped determine where the most brain damage potential lies, allowing me to protect the patient’s ability to speak, move, and see.

Thanks to functional brain imaging (functional MRI) and other neurological technologies, I can perform awake craniotomies on patients whose tumors were previously thought to be inoperable.

A functional MRI scan is especially important because it identifies functional areas of the brain that are impacted by the tumors. Over the past couple of years, neuronavigation and new types of anesthesia have also made the procedure safer and easier to conduct. The most reassuring aspect that relieves my patients is when I tell them that they will not feel pain when they are either awake or sedated during an awake craniotomy.

For further information about awake craniotomy, read my full press release here: http://www.prweb.com/releases/2013/2/prweb10445390.htm or learn about other procedures I perform by reading my blog.

 

Thanks for reading,

Ramin Rak

Microdiscectomy

Hi all, Ramin Rak here with another blog post about the complex neurosurgical procedures I complete at Neurological Surgery, P.C.

I specialize in the completion of surgeries meant to treat ailments affecting the brain and spine. In previous blog posts I have discussed my work with the NSPC Brain Tumor Center and spinal procedures such as Spinal Fusion and the X-Stop Procedure. One spinal procedure that I have not written about is a microdiscectomy.

When a patient complains of leg pain I can use magnetic resource imaging (MRI) or a computer tomography (CT) scan to determine if the patient has a herniated disc.

Using these results, I then decide whether or not a microdiscectomy will relieve the patient’s symptoms.

This spinal procedure is primarily used to treat leg pain, specifically leg pain arising from a herniated lumbar disc. Compression or impingement on the nerve root, defined as bone colliding with or striking the nerve root, will cause considerable leg pain. A microdiscectomy is used to relieve leg pain, and in many cases the patient will feel relief immediately after completion of surgery.

When completing a microdiscectomy, I examine the disc and nerves under a high powered microscope so that I only need to make a small incision.

By using this microneurosurgical technique instead of performing a discectomy, patients experience a much smaller recovery time because there is less tissue damage.

After the incision is made, I move the back muscles off of the bony arch (lamina) of the spine. I am then able to enter the spine by removing a membrane over the nerve roots and visualize the nerve using operating glasses. Once herniated disc material is removed, the procedure is complete.

For more information about the types of spinal procedures I have completed, take a look at my other blog posts or view some of the surgical videos I have uploaded to Vimeo by clicking here.

Thanks for reading,

Ramin Rak

 

PS For more information on the completion of a microdiscectomy, visit this link.

Kyphoplasty Surgery

Hello again, my name is Ramin Rak and I am writing this post to share information about another complex spinal procedure that I perform at Neurological Surgery, P.C.: Kyphoplasty Surgery.

I am one of six Neurological Surgery, P.C. neurosurgeons who performs kyphoplasty surgery. The others are:

  • Dr. Stephen D. Burstein
  • Dr. William J. Sonstein
  • Dr. Benjamin R. Cohen
  • Dr. Artem Y. Vaynman
  • Donald S. Krieff, D.O., F.A.C.O.S.

I perform kyphoplasty surgery in order to reverse spinal compression caused by a spinal bone fracture.

Individuals who experience compression lose vertebral body height and experience intractable pain. Fortunately kyphoplasty surgery removes pain relief roughly 48 hours after completion of the procedure, and patients can leave the hospital on the same day the procedure is completed.

Once the patient has been sedated, I make a small incision in the patient’s back so that I can insert a narrow tube-like needle into the fractured vertebral body.

I then use an imaging technique called fluoroscopy, which uses x-rays to provide a real-time moving image of the patient’s spinal structure, to guide the needle into the fractured area. Once a path has been made to the spot of the fracture, I insert a balloon into the tube, guide it to the vertebrae, and then slowly inflate it. The inflated balloon elevates the spinal structure, which restores vertebral body height. Next I remove the balloon and fill the cavity created by the balloon with a cement-like material that hardens quickly and stabilizes the spinal structure.

The entire procedure takes roughly one hour per affected vertebra and following conclusion of the procedure, the patient is observed in the recovery room until my doctors determine that he or she can leave.

This is how I complete kyphoplasty surgery at Neurological Surgery, P.C.

Learn more about how I complete this procedure by reaching out to me on Doctor’s Hangout.

Thanks for reading,

Ramin Rak

 

Ramin-Rak-Kyphoplasty

During kyphoplasty surgery, a balloon is inserted into the spine and inflated via a small tube.

Schwannoma

Thank you for visiting my blog. My name is Dr. Ramin Rak and I am a surgeon with Neurological Surgery, P.C.

I specialize in treating complex spinal and brain complications at the eleven different medical facilities affiliated with Neurological Surgery, P.C. and I am a member of the organization’s Neurosurgeon Brain Tumor Team.

The Brain Tumor team includes an Endovascular Neuroradiologist, two Neuro-oncologists, a Neuropsychologist, myself, and seven other neurosurgeons:

  • Dr. Michael H. Brisman, M.D., F.A.C.S.
  • Dr. Jeffrey A. Brown, M.D., F.A.C.S.
  • Dr. Lee Eric Tessler, M.D., F.A.A.N.S.
  • Dr. Alan Mechanic, M.D., F.A.C.S.
  • Dr. Robert N. Holtzman, M.D.
  • Dr. Vladimir Dadashev, M.D.
  • Dr. Gerald M. Zupruk, M.D., F.A.A.N.S.

The rest of the Brain Tumor Team and I work to treat brain tumors and complications caused by tumors, including gioblastoma, medulloblastoma, acoustic neuroma, and schwannoma.

Schwannoma is a homogenous tumor that is made up entirely of Schwann cells, which conduct nervous impulses along axons, provide trophic support for neurons, and support nerve development and regeneration.

The tumor cells are always on the exterior of the nerve though the tumor itself can cause nerve damage by pushing the nerve aside or into bone. Schwannomas become malignant in less than 1% of cases and are slow growing, but should still be treated if weakness numbness, pain or other symptoms are seen.

The Brain Tumor Team at NSPC uses surgery or stereotactic radiosurgery to treat schwannomas with radiosurgery being an option when the tumor is located in the head or spine.

The most common treatment is stereotactic radiosurgery, or the use of a machine called the Gamma Knife to focus high-powered x-rays at the spot of the tumor. Between 80 and 90% of the patients who opt instead to have surgery report that pain, weakness, and numbness disappears following the procedure.

Learn more about how the Brain Tumor Team treats schwannomas here.

Thank you for reading,

Dr. Ramin Rak

 

Ramin Rak Schwannoma

This is an example of a schwannoma. It typically has dense areas called Antoni A (black arrow) and looser areas called Antoni B (blue arrows). The cells are elongated (spindle shaped) and the nuclei have a tendency to line up as you see here in the Antoni A area. (via ucsf.edu)

My Second Awake Craniotomy

Good afternoon and welcome back to my blog.

My name is Ramin Rak, I am a neurosurgeon with Neurological Surgery, P.C. in New York and one of my specialties is performing awake craniotomies.

In July of 2010, I received media attention after completing the first awake craniotomy that had ever been performed at the North Shore-LIJ Huntington Hospital.

The procedure was notable for me because it was only my second awake craniotomy.

The need for the procedure was uncovered after 23-year-old Boris Arrazia experienced a seizure while driving his car. Arrazia’s passenger was able to navigate the car to the side of the road and put it in park, and a passerby performed CPR and then called for help.

Arrazia was brought to Huntington Hospital where doctors uncovered the cause of the stroke: a tumor located in the temporal lobe of his brain.

Due to the tumor’s unusual location, the tumor did not show up when using advanced imaging techniques. Because the tumor was right on his speech area, there was no way to map and understand how we are going to control the reception of the brain without the patient being awake. By performing an awake craniotomy, my team was able to make sure we did not damage areas of the brain dealing with speech during surgery by asking Arrazia to repeat phrases or describe pictures. Arrazia recounts:

“I was nervous when Ramin Rak first told me the diagnosis, but happy to hear that the tumor was operable,” Arriaza said. “Ramin Rak told me that I would be conscious for the surgery, and that it might be uncomfortable and possibly a little painful. During the surgery, they showed me pictures and asked me to name the objects [like] a horse [or] a table.”

Though there are a lot of risks associated with awake craniotomies, including serious bleeding, there were no complications seen while removing Arrazia’s tumor. Four days later, he walked out of the hospital and reunited with his family.

Learn more about this particular awake craniotomy by taking a look at the media coverage this procedure received:

http://www.northshorelij.com/NSLIJ/Islip+Man+Undergoes+Brain+Surgery+While+Awake  

http://huntington.patch.com/articles/huntington-hospital-doc-performs-awake-craniotomy

 

If you are interested in learning more about how I perform awake craniotomies, visit my Quora profile.

Thank you for reading,

Ramin Rak

Ramin Rak awake craniotomy

Boris Arrazia thanks Ramin Rak following completion of the awake craniotomy.

Leslie Munzer Neurological Institute

Hi all, Dr. Ramin Rak here with another blog post about neurosurgery.

Some of my past blog posts have focused on complex neurosurgical techniques that I use, but I do not spend all of my time in the operating room. Part of my success can be attributed to the education along the way, from my eight years of undergraduate and medical schooling at the Free University of Brussels to the countless residencies I completed in hospitals throughout the United States. For this reason, I make it a priority to give back to the medical community by educating them on the techniques that I use. One way that I do so is by keeping up this blog, but I also present lectures at medical seminars across the country.

Back in 2009 I was asked by the Leslie Munzer Neurological Institute (LMNI) to speak at a comprehensive educational seminar on Brain Tumor and Stroke Awareness.

This two hour seminar took place at the Jefferson’s Ferry Lifetime Retirement Community’s Community Center in New York, and lecture topics included, “Stroke- Treatment, Recovery, and Prevention,” “Current Treatments of Brain Tumors,” “A Stroke Overview,” and “New Chemotherapy Options for the Treatment of Brain Tumors.” My lecture was titled “Advancements in Brain Tumor Surgeries” and I discussed advanced microneurosurgical techniques like awake craniotomies, the Gamma Knife procedure, and the CyberKnife system.

The Leslie Munzer Neurological Institute was formed in 2006 by Neurological Surgery, P.C. and at the time was called The Long Island Neurological Institute, Inc.

This organization coordinated funds for research related to the brain and spinal cord while supplying information to patients and the medical community about neurological ailments.

The organization changed its name in 2008 in memory of Leslie Munzer, who passed away in 2004 from a ruptured arteriovenous malformation (AVM).

Shortly after her passing, the Munzer family had formed a charity in her name to raise funds for AVM research and awareness, and in 2008 donated the collected funds to The Long Island Neurological Institute, Inc.

You can learn more about my efforts to educate the neurosurgical community with The Leslie Munzer Neurological Institute and with other organizations by viewing my other blog posts.

Thank you for reading,

Dr. Ramin Rak

Ramin Rak at May 2009 Seminar

Dr. Ramin Rak (second from the right) and the other speakers asked to present a lecture for the May 2009 Leslie Munzer Neurological Institute (LMNI) seminar.