Zoltan Balogh: The living proof
In July , while riding his bicycle, Balogh suffered a massive stroke in the right side of his brain that could have left him partially paralyzed and unable to speak clearly. What's more, the stroke might have affected Balogh's powers of spatial perception, essential for a scholar in topology, a branch of mathematics that deals with the study of abstract geometric figures. Instead, unlike the scenario for the roughly 40 percent of patients who do not survive such an episode, in Balogh's case doctors put a drug commonly used in the treatment of heart attacks to an innovative and still experimental use: They injected it directly into the huge clot in Balogh's brain. Within an hour the mathematician was out of the woods. "This is a young guy who was face-to-face with death or severe disability," says Dr Arthur Pancioli, 35, of the University Hospital in Cincinnati, where Balogh was treated. "Because he had access to the hottest technology going and received it really quickly, he walked away fully recovered."
That result seemed remote on the summer morning when Balogh set out on his road bike from the Oxford, Ohio, home he shares with Agnes, 38, and their sons Adam, 12, and Daniel, 10. Around noon, exhausted and seized with a sudden feeling of pressure in his head, he collapsed on the road. Local mechanic Bob Miller and his then-14-year-old daughter Jennifer had just rounded a bend in their pickup when they spotted the semiconscious professor. They managed to get him to a nearby farmhouse and summon an ambulance. At 12:50 p.m., Balogh arrived at Oxford's McCullough-Hyde Memorial Hospital, where his family converged. "He was totally not my husband," says Agnes. "He kept repeating, 'I want to go on a nice bike ride.'
When a CAT scan revealed that Balogh had a clot in a cerebral artery, emergency physician William Ross realized he was suffering a severe stroke. Ross also knew that the anticlotting drug t-Pa (tissue plasminogen activator) might be effective - but it had to be administered within a three-hour window. At 1:40 p.m., after conferring with Daniel Woo, a neurologist with the Greater Cincinnati Stroke Team, doctors started Balogh on an intravenous dose of t-Pa, then had him helicoptered 45 miles to the University Hospital in Cincinnati. "I remember the liftoff and seeing all the clouds on a nice sunny day," says Balogh. "I wasn't completely aware of how bad the situation was."
But Woo decidedly was. When he stood on Balogh's left side, "I asked him to move his left arm," says Woo, 31. "He couldn't, but he believed he could." That told Woo the stroke had damaged the right hemisphere of Balogh's brain, which controls left-side awareness. His diagnosis was confirmed when a cerebral angiogram revealed that a clot in one of the largest vessels supplying the right hemisphere had not been eliminated by the IV t-Pa. With time running out, Woo and neuroradiologist Dr Robert Ernst took an aggressive step: Feeding the drug through a catheter inserted in Balogh's femoral artery, they injected the t-Pa straight into the clot, a technique that had been tried on only 30 patients before - with mixed results.
Within an hour, Balogh began to move and speak normally. A follow-up CAT scan revealed the remarkable outcome: Not only had the clot disappeared, says Woo, but "the main cognitive areas of the brain seemed to be completely unaffected." Balogh was discharged from the hospital four days later, and in October he accompanied son Adam on a 50-mile bike ride. Today he is one of the few patients to have benefited from this pioneering procedure. But once it is proved in clinical trials, says Woo, "we hope that we can reach many more."
JOC/EFR August 2016
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